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Legion560

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After 9 months as a gen surg intern at a reasonably reputable university program Ive made a couple of observations. The gen surg environment is seriously a world based on retribution and pain. No one gives a rat's arse if you kept 4 services you are cross-covering locked down tight when on call. If you miss seeing a hemodynamically stable NAD patient with a little nausea because you were trying to save an acutely decompensating person losing her airway and you get ripped a new one in the morning by people who shoot first and never give you the chance to clarify issues. WTF? Yes I know you all have been there before, and Yes, I know it is the intern's job to eat $hit and like it, but things are starting to become ridiculous. I am convinced that no junior resident in my program really enjoys being at the hospital.

I guess it would be a bad career move to point out to my chiefs and attendings that they are being unfair. Surely there has to be some other strategy to handling this kind of stuff (besides bending over and taking it in the rear-Im running out of vaseline and patience)

I love the OR but I hate my job. :mad:

Legion.
 

Tigger14

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I would say it depends on your program. If your senior residents are also unhappy, or your attendings are also unhappy, then no, it probably does not get better.

I think everyone has difficult times, and a couple of things helped me:
1. One of my co-chiefs is my best friend. We got along from the start, and it helps tremendously to know that you are not alone/the only one getting yelled at/the only one who makes dumb mistakes. If you have a friend in the program, it helps.
2. Keep a hobby/interest/something that you value. In surgery it is hard to do, and easy to get home, fall asleep and get up to go back to work. Whether it is exercise, reading, biking, watching TV, it helps.
3. There were times when student loans were the only thing between me and quitting.
4. There were also times when my family and other friends (not just my co-chief) were there to remind me why I chose surgery, that there is an end, and that I am not a quitter. I called one up, near the end of PG2 year, and said something like, "I am done. I am tired of the abuse, the punishment, the no sleep/no exercise/no eating, and I don't think the privilege of operating is worth this." She said "no." Just that. Her follow up was that quitting is not the answer, and if I moved on to the next rotation and still felt that way, there was more to think about. The next rotation did get better, and while I almost quit again at the end of PG4 year (I actually wrote the resignation letter), somehow it looks like I will finish this phase... if not in the same shape I was in 5 years ago. :rolleyes:
5. Lastly, it bears saying that if you have any of the signs of depression, go to your doctor. They will have medical and non-medical resources to help you.

God bless my family and friends for putting up with me and not strangling me in my sleep. I definitely would not have made it without them.:)
 

filter07

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Is it safe to assume that interviews at the places you mentioned, made it seem like everyone was happy with no problems at all?
 
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Don't let them break you and Don't become like them.

Words to live by. If you train with a bunch of people that are horrible and do/say horrible things to other people, it's like two sides of a coin: you either become like them, or you do the opposite, and say, "I don't want to be like that".

Don't be like that - be a good person in a sea of bad. It CAN be done (because it HAS been done).
 

toxic-megacolon

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I would say it depends on your program. If your senior residents are also unhappy, or your attendings are also unhappy, then no, it probably does not get better.

I agree that when everyone is unhappy is a bad sign, however in my program, all the residents seem to LOVE working 100+ hours per week. They can't get enough. Its really hard to keep your spirits up when you are so worn out and no one else seems affected!:sleep:
 

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Did my first call on a new service last night. Covering the hospital with no senior resident in house. Didn't get a second of sleep. On top of it all, had to scrub in on a bull**** case post-call which ended up taking too long. I was really not funtioning well at that time. At 3AM last night while watching a bleeder in the SICU, i kept thinking, how can I endure this for 5 years? I hope I can.
 

Legion560

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I agree that when everyone is unhappy is a bad sign, however in my program, all the residents seem to LOVE working 100+ hours per week. They can't get enough. Its really hard to keep your spirits up when you are so worn out and no one else seems affected!:sleep:

I dont care about working long hours. I like the actual job, but I dont like being treated like $hit on a daily basis. And if you say anything about it, people will think you are a big wuss, when really you are trying to clarify issues and stand up for yourself.
 

Pilot Doc

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The being treated like **** on a daily basis part should get better as you move up in the progam. The more senior you get, the fewer people can treat you poorly. At this point, everyone you interact with, perhaps save med students, has higher status than you - if they have had a bad day, don't like you, don't want to do their job, etc, they can take it out on you. You can't (or shouldn't) do that to anyone. Once you're a chief, only the attendings generally take out their frustrations on you.

For right now, you have to take a dual attitude. Somewhere deep inside, know that the system is flawed and you are a decent person. It'll eat you alive otherwise. But you have to behave as if everything is your fault and look at every negative interaction you have to figure out how you can change it. e.g. Grumpy chief in the morning cause he hasn't had his coffee - then get him coffee before rounds - or have the med student do it :)
 

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It gets better! Just remember that. I don't think there is a surgery resident out there that didn't feel like you at some point during their PGY1 year. Once you get more experience and knowledge the stress level drops, you gain more confidence and can defend yourself to criticisms, etc.

Just hang it there - the intern year is almost over for you and life will get better.
 

Littlemantate

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The being treated like **** on a daily basis part should get better as you move up in the progam. The more senior you get, the fewer people can treat you poorly. At this point, everyone you interact with, perhaps save med students, has higher status than you - if they have had a bad day, don't like you, don't want to do their job, etc, they can take it out on you. You can't (or shouldn't) do that to anyone. Once you're a chief, only the attendings generally take out their frustrations on you.

For right now, you have to take a dual attitude. Somewhere deep inside, know that the system is flawed and you are a decent person. It'll eat you alive otherwise. But you have to behave as if everything is your fault and look at every negative interaction you have to figure out how you can change it. e.g. Grumpy chief in the morning cause he hasn't had his coffee - then get him coffee before rounds - or have the med student do it :)

For someone preaching about how the system is broken this last part is pretty naive and lame advice. Medical students are their to learn about surgery and you guys are there to show them why you went into surgery and pursuade them to like surgery the best you can-especially considering gensurg is a dying field that is looked upon as not very well these days. The reason things do not change is that-residents treat medstudents like crap and they get a poor opinion of surgery-then less go into surgery and the ones that still do treat the next medstudnets like crap because that is how they were treated. Then those same people become 2nd years and treat the next interns like crap cause they were treated like crap as interns.

If someone stopped the cycle at the medstudent level-treated medstudents really well and nicely and they would never have those ill-thoughts toward anyone and would be nicer people throughout their residency. You sound like just the type of resident as a student every student would hate. The typical power complex since you were being abused by your entire OWN residency that YOU chose-so you take it out on a student who has NO CHOICE about being there. Whos fault is it if you CHOOSE a program and they abuse you-makes you look like the fool.
 

MD Dreams

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For someone preaching about how the system is broken this last part is pretty naive and lame advice. Medical students are their to learn about surgery and you guys are there to show them why you went into surgery and pursuade them to like surgery the best you can-especially considering gensurg is a dying field that is looked upon as not very well these days. The reason things do not change is that-residents treat medstudents like crap and they get a poor opinion of surgery-then less go into surgery and the ones that still do treat the next medstudnets like crap because that is how they were treated. Then those same people become 2nd years and treat the next interns like crap cause they were treated like crap as interns.

If someone stopped the cycle at the medstudent level-treated medstudents really well and nicely and they would never have those ill-thoughts toward anyone and would be nicer people throughout their residency. You sound like just the type of resident as a student every student would hate. The typical power complex since you were being abused by your entire OWN residency that YOU chose-so you take it out on a student who has NO CHOICE about being there. Whos fault is it if you CHOOSE a program and they abuse you-makes you look like the fool.

I think PilotDoc was just kidding! I wouldn't be so harsh. This is coming from a Med student that decided not to go into gen surg because of all the jerks yelling at him.
 

Tigger14

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I think PilotDoc was just kidding! I wouldn't be so harsh. This is coming from a Med student that decided not to go into gen surg because of all the jerks yelling at him.

Actually, I think PilotDoc (you can correct me if I am wrong) was saying that while you may be yelled at or abused, you should not turn around and do it to others. He/she is just saying that as a young resident, you should not take the decibel level of feedback into account and ignore the core message, which may be that you can do something better. Sometimes it is just abuse, for the sake of abuse, but there may still be a lesson to learn under the bark of your upper-levels. Just my 2 cents.
 
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surfsurg

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I would say it depends on your program. If your senior residents are also unhappy, or your attendings are also unhappy, then no, it probably does not get better.

I think everyone has difficult times, and a couple of things helped me:
1. One of my co-chiefs is my best friend. We got along from the start, and it helps tremendously to know that you are not alone/the only one getting yelled at/the only one who makes dumb mistakes. If you have a friend in the program, it helps.
2. Keep a hobby/interest/something that you value. In surgery it is hard to do, and easy to get home, fall asleep and get up to go back to work. Whether it is exercise, reading, biking, watching TV, it helps.
3. There were times when student loans were the only thing between me and quitting.
4. There were also times when my family and other friends (not just my co-chief) were there to remind me why I chose surgery, that there is an end, and that I am not a quitter. I called one up, near the end of PG2 year, and said something like, "I am done. I am tired of the abuse, the punishment, the no sleep/no exercise/no eating, and I don't think the privilege of operating is worth this." She said "no." Just that. Her follow up was that quitting is not the answer, and if I moved on to the next rotation and still felt that way, there was more to think about. The next rotation did get better, and while I almost quit again at the end of PG4 year (I actually wrote the resignation letter), somehow it looks like I will finish this phase... if not in the same shape I was in 5 years ago. :rolleyes:
5. Lastly, it bears saying that if you have any of the signs of depression, go to your doctor. They will have medical and non-medical resources to help you.

God bless my family and friends for putting up with me and not strangling me in my sleep. I definitely would not have made it without them.:)


thanks tigger14. well written. I have one question and i hope it is not too personal. why did you almost quit at the end of PGY4 year? it seems odd to wanna quit when you are so close to the end.
 

Pilot Doc

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Sometimes it is just abuse, for the sake of abuse, but there may still be a lesson to learn under the bark of your upper-levels.

Excellent synopsis.

About the med student, I was half joking. Medical education is a give and take. The student does something to make the teacher's life easier and the teacher teaches in return. (When I say student, that is generic. An intern is the chief's student in this case, the cheif the attending's, etc.) This is substantially different from education prior to the third year of med school where someone else incentivizes the teacher to teach the student, and is a source of much confusion.

Back to the coffee - I see nothing inherently wrong with sending a med student to get the chief's coffee if you as the intern decide someone needs to get coffee. That decision comes with an obligation to take the time to impart skills and experience to the student. Otherwise it just abuse.
 

Pilot Doc

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Medical students are their (sic) to learn about surgery and you guys are there to show them why you went into surgery and pursuade (sic) them to like surgery the best you can-especially considering gensurg is a dying field that is looked upon as not very well these days.

I disagree on a variety of points.
1) medical students do rotate on surgery to learn. They are also there to help carry the clinical workload.
2) Selling surgery is at best a minor part of a surgery resident's education mission. Even at its peak, the vast majority of medical students did not choose general surgery, yet they will continue to care for patients with diagnosed and undiagnosed surgical problems. Our primary mission is to give the future internist, pediatrician, radiologist, etc a working knowledge of surgery.
3) General surgery is not considered a dying field. CT surg maybe, but not GS. Competition for a surgery spot is quite intense. There are hundreds more US Senior GS applicants than spots.
 

resxn

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In general slavery, my motto was:

They can beat me down, but they can't stop the clock.

Course, I only had to suffer a year before eating the greener grass (or boogers, I guess) in ENT.
 

SLUser11

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Back to the coffee - I see nothing inherently wrong with sending a med student to get the chief's coffee if you as the intern decide someone needs to get coffee. That decision comes with an obligation to take the time to impart skills and experience to the student.

While that's completely inappropriate, it may be a little less inapropriate if the student had the option of saying no, which I doubt they do, and doubt even more that they think they do.

Honestly, it reaks of the old school [email protected]#t-to-win-me-over-and-get-me-to-teach-you mentality, which is kind of dinosaur-ish, but obviously still very prevalent.

I disagree on a variety of points.
1) medical students do rotate on surgery to learn. They are also there to help carry the clinical workload.

While I don't disagree with this, I just don't like your wording. "Carry the clinical workload" sounds to me like gathering vitals, etc. A student's primary role should be more a long the lines of participating in the clinical care of the patient, with a secondary role as vitals b#tch.

Students usually create a larger workload for the resident as opposed to helping to reduce the workload, and this should not upset either the student or the resident, as it is an inherent part of the teaching process.
 

Pilot Doc

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SLUser11 said:
While that's completely inappropriate, it may be a little less inapropriate if the student had the option of saying no, which I doubt they do, and doubt even more that they think they do.
I think it's entirely appropriate to, in the situation I proposed, tell the student to do it and give them no choice. The situation involved is palliating an abusive chief - and the intern may have work to do while somebody needs to get the coffee.

SLUser11 said:
Honestly, it reaks of the old school [email protected]#t-to-win-me-over-and-get-me-to-teach-you mentality, which is kind of dinosaur-ish, but obviously still very prevalent.

"Win me over and get me to teach you" is the way it works. Nothing dinosaurish about it. Residents and attendings have a primary responsibility to care for patients. Students and residents need to earn their keep. There are lots of things that have to get done to make a clinical service run.
It takes time to teach, those being taught need to assume some of the teacher's responsibilities to free up educational time.

SLUser11 said:
While I don't disagree with this, I just don't like your wording. "Carry the clinical workload" sounds to me like gathering vitals, etc. A student's primary role should be more a long the lines of participating in the clinical care of the patient, with a secondary role as vitals b#tch.
My wording was actually "help carry the clinical workload. Vitals b#tch is an important part of the clinical care of the patient. Educational? not at all. But try rounding with no vitals.

SLUser11 said:
Students usually create a larger workload for the resident as opposed to helping to reduce the workload, and this should not upset either the student or the resident, as it is an inherent part of the teaching process.

If that's the case you are not using your students effectively or (more likely) your institution prevents you from using them effectively. Students, when allowed responsibility, can be an invaluable assistance to residents.

All this sounds hard core and malignant, I know. The flip side of expecting students to fetch coffee and get vitals is an incredibly important, near sacred, responsibility to educate them and send them off at the end of the rotation with useful clinical and diagnostic skills. As I've said before, without that commitment and sacrifice on the part of the residents, it is all abuse.
 

SocialistMD

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For someone preaching about how the system is broken this last part is pretty naive and lame advice. Medical students are their to learn about surgery and you guys are there to show them why you went into surgery and pursuade them to like surgery the best you can-especially considering gensurg is a dying field that is looked upon as not very well these days. The reason things do not change is that-residents treat medstudents like crap and they get a poor opinion of surgery-then less go into surgery and the ones that still do treat the next medstudnets like crap because that is how they were treated. Then those same people become 2nd years and treat the next interns like crap cause they were treated like crap as interns.

If someone stopped the cycle at the medstudent level-treated medstudents really well and nicely and they would never have those ill-thoughts toward anyone and would be nicer people throughout their residency. You sound like just the type of resident as a student every student would hate. The typical power complex since you were being abused by your entire OWN residency that YOU chose-so you take it out on a student who has NO CHOICE about being there. Whos fault is it if you CHOOSE a program and they abuse you-makes you look like the fool.

Well, maybe if some of the medical students would show initiative and get the coffee without being told to get it...;)
 

ExtraCrispy

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I trained at a medical school where medical students took an active role in patient care. We were scut-heavy, and as fourth-year students we were expected to act as another set of interns on the floor.

Even in that environment, I was *never* a "vitals b****," and I will never subject any of my students to that sort of attitude. It's much more valuable to have students collect the data on their patients, so that they may process that data, put it together, and think of meaningful plans. We learn through caring for our patients, not through secretarial work. Done properly, this approach by no means excuses students from their responsibility to share in the workload. For example, on my sub-internships, I pre-rounded on half of the service every morning, no matter how many other interns were with me. By pre-round, I mean examine the patient, write the note, figure out the plan for the day. Did that help out the team? Heck yeah. And it was a more worthwhile use of my time than simply recording vitals and passing them over to an intern.

Even when students offer, I never allow them to be scut monkeys and do secretarial work that has no educational benefit for them. If they want to help out more, I ask them to follow more patients, so that they can learn at the same time that they contribute to the team.

And I will never demand that med students do scutwork to "earn" precious teaching time from me. I have as much of an interest in their education as they do. These students will be my colleagues some day. They'll be responsible for patients. And as a resident in a teaching hospital, I have a responsibility to help students learn to care for patients, and not to kill them. Teaching isn't a privilege to bestow upon med students when I feel like it - it's part of my job.
 

Littlemantate

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Pilotdoc you are a tool-you are the type of resident I would have embarrased in front of everyone when I rotated through. The surgery resident who tried to be a hard-ass on me got called out on her lack of knowledge and ended with calling her a bitch in front of everyone-she shut the hell up after that and I did not have to speak to her. I had zero interest in surgery and passed my rotation without having to kiss ass, or put up with bull. Med students do NOT have to take that crap.

And sorry bro, GS is a dying field looked down upon by most these days as extreme hours for no compensation and only doing like 2 procedures since everything is specialized. I mean what do you guys do anymore-hernias and appys-the rest is done by specialssts-and if you call an average step 1 of 220 as compeititve (this was last years GS average acceptee)-then you have the wrong idea of what that means.

Anyway you area tool, probably always will be and will be making 140 bucks for doing an appy at 1am when you are 50 years old-um your right-it IS a desirable field:laugh:
 

powermd

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Anyway you area tool, probably always will be and will be making 140 bucks for doing an appy at 1am when you are 50 years old-um your right-it IS a desirable field:laugh:

Sooner or later demand will have to wildly outpace supply for surgery in this country, leading to an access problem. It would make sense that surgeon's reimbursement should rise substantially- unless we go to a single payor health funding system. I really doubt our monkey-ass government could organize that anytime soon. It is truly pathetic how poorly GS docs are reimbursed considering how highly trained they are.
 

ExtraCrispy

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And sorry bro, GS is a dying field looked down upon by most these days as extreme hours for no compensation and only doing like 2 procedures since everything is specialized. I mean what do you guys do anymore-hernias and appys-the rest is done by specialssts-and if you call an average step 1 of 220 as compeititve (this was last years GS average acceptee)-then you have the wrong idea of what that means.

:


Hey buddy, the people on this board defending you come from the "dying field" that you're knocking. Stop the juvenile specialty bashing. You obviously don't like it, so don't go into it. Don't criticize those who actually find something exciting and rewarding about surgical care. (And there are a heck of a lot more people who fit into that category than you insinuate. There were next to zilch unfilled spots in last year's match.)
 

Littlemantate

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Hey buddy, the people on this board defending you come from the "dying field" that you're knocking. Stop the juvenile specialty bashing. You obviously don't like it, so don't go into it. Don't criticize those who actually find something exciting and rewarding about surgical care. (And there are a heck of a lot more people who fit into that category than you insinuate. There were next to zilch unfilled spots in last year's match.)

Dude I am not bashing the field or anyone in it-I initially wanted to do surgery and gen surg is the road to many others-but actually becoming a GS and not specializing I truly believe is a dying field, even according to the attendings I work with that tell me GS these days perform a handful of procedures-I forgot gallstones-hernia and appy-The oldschool GS performed like surgery on every organ but now specialities do that-I mean GS do not even operate on the colon anymore where that was a super common procedure before specialization-It is sad when the reimbursment is ridiculous that is all-if it is not dying than I am glad for you-I hope it takes off for all your guys sakes, you deserve it for the hard work-

However the tools who believe scutting out medstudents if acceptable-you deserve to cut your hand off in surgery-gluck:thumbup:
 
M

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Maybe they don't operate on the colon in academic centers, but in the community hospitals I've been to, the general surgeons work on the colon, the chest and do vascular and endocrine work in addition to their "gallstones-hernia and appy". Again, I'm not trying to say this is everywhere, just a few places I've been.
 

Winged Scapula

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...I mean GS do not even operate on the colon anymore where that was a super common procedure before specialization..

This is an example of a lack of experience. If you work with private practice general surgeons in the community you will see they do lots of colon work. Now they may not do APRs or more advanced procedures, but during my residency I did more sigmoid colectomies, right colons, diverting colostomies and the like with the community private practice surgeons than I did in the university hospital with the colorectal fellowship trained guys.

I have seen the above pattern repeated at other hospitals as well.
 

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I trained at a medical school where medical students took an active role in patient care. We were scut-heavy, and as fourth-year students we were expected to act as another set of interns on the floor.

Even in that environment, I was *never* a "vitals b****," and I will never subject any of my students to that sort of attitude. It's much more valuable to have students collect the data on their patients, so that they may process that data, put it together, and think of meaningful plans. We learn through caring for our patients, not through secretarial work. Done properly, this approach by no means excuses students from their responsibility to share in the workload. For example, on my sub-internships, I pre-rounded on half of the service every morning, no matter how many other interns were with me. By pre-round, I mean examine the patient, write the note, figure out the plan for the day. Did that help out the team? Heck yeah. And it was a more worthwhile use of my time than simply recording vitals and passing them over to an intern.

Even when students offer, I never allow them to be scut monkeys and do secretarial work that has no educational benefit for them. If they want to help out more, I ask them to follow more patients, so that they can learn at the same time that they contribute to the team.

And I will never demand that med students do scutwork to "earn" precious teaching time from me. I have as much of an interest in their education as they do. These students will be my colleagues some day. They'll be responsible for patients. And as a resident in a teaching hospital, I have a responsibility to help students learn to care for patients, and not to kill them. Teaching isn't a privilege to bestow upon med students when I feel like it - it's part of my job.

Can every resident be like you??! :love: :love:
 
M

Mr. McDuck

This is an example of a lack of experience. If you work with private practice general surgeons in the community you will see they do lots of colon work. Now they may not do APRs or more advanced procedures, but during my residency I did more sigmoid colectomies, right colons, diverting colostomies and the like with the community private practice surgeons than I did in the university hospital with the colorectal fellowship trained guys.

I have seen the above pattern repeated at other hospitals as well.

Love the new avatar. :laugh:

I just wanted to mention that a few of our general surgeons do APRs. One of the groups also does lap colons. They aren't doing them every day, or even every week, but they do them. They did one today, in fact.
 

Winged Scapula

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Love the new avatar. :laugh:

Thanks...isn't it great? Found it when I was looking for something a little different.

I just wanted to mention that a few of our general surgeons do APRs. One of the groups also does lap colons. They aren't doing them every day, or even every week, but they do them. They did one today, in fact.

Sounds like you've got some general surgeons with interest in advanced colorectal cases. That's great for you and the others. Thanks for pointing that out as well as the wide variety of cases that general surgeons CAN do - including vascular, advanced laparoscopic, etc. Med students and even residents tend to have a blind eye when it comes to practices outside of their experience.
 

SLUser11

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Feb 22, 2005
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Pilotdoc you are a tool

Pilot Doc- I don't think you're a tool....I just disagree with your methods.

I trained at SLU, and it was very much an old school urban academic environment. Many of the surgeons were older, and trained in the Northeast, so that tradition was upheld. Student tasks were menial, and residents were frequently jerks, etc.

I left SLU for many reasons, the biggest being that I hated the city, and had been there for 8 years. However, another reason was that I wanted to train in a healthy learning environment with the least amount of antagonism possible.

You're right that the old way of teaching works, but the training of surgeons is a changing world, and I think that we need to change with it. The reason new rules (like 80 hrs) don't work is because people refuse to change/come up with new methods that also work, maybe even work better......


.....OK I'm off my soapbox now.
 
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