preferntial treatment in OMS setting

[Ancient_amalgamator]

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I have a genuine question: How are residents supposed to address obvious preferential treatment in the service/operating room?

How does it make sense for a junior resident to perform the major portions of big cases while a fifth-year or chief resident stands there retracting for them? This has already been discussed with multiple faculty members, and the response is always some variation of, “Yeah, I hear you. Just let it go. Next month will be different" Since they will be heading to medical school
What makes it even more frustrating is when the preferential treatment appears to be based on personal attachment rather than training level, competency, or graduated responsibility. Apparently, one resident reminds an attending of his daughter. Okay—but that should not determine who receives the operative experience.
Junior residents absolutely deserve meaningful experience, but not at the repeated expense of senior residents who are expected to graduate independently competent. At some point, this stops looking like education and starts looking like favoritism and hypocrisy.

 

[White_Sponge_Nevus]

I have a genuine question: How are residents supposed to address obvious preferential treatment in the service/operating room?

How does it make sense for a junior resident to perform the major portions of big cases while a fifth-year or chief resident stands there retracting for them? This has already been discussed with multiple faculty members, and the response is always some variation of, “Yeah, I hear you. Just let it go. Next month will be different" Since they will be heading to medical school
What makes it even more frustrating is when the preferential treatment appears to be based on personal attachment rather than training level, competency, or graduated responsibility. Apparently, one resident reminds an attending of his daughter. Okay—but that should not determine who receives the operative experience.
Junior residents absolutely deserve meaningful experience, but not at the repeated expense of senior residents who are expected to graduate independently competent. At some point, this stops looking like education and starts looking like favoritism and hypocrisy.

Unfortunately we have very little control over this as trainees. It's luck of the draw and nothing we can do about it

 

[axiumgod]

Say something in the moment. “Actually I’d like to do that I’m trying to get more reps in.” No one will care more about your education as much as you do. If you’re a senior resident, then act like one and pull rank if need be

 

[Ancient_amalgamator]

Say something in the moment. “Actually I’d like to do that I’m trying to get more reps in.” No one will care more about your education as much as you do. If you’re a senior resident, then act like one and pull rank if need be

I did say something, but there is only so much you can do to assert your seniority with the chair, my friend—especially when he specifically chose her for his service out of three chiefs and three senior residents.

 

[Rush_motion]

I did say something, but there is only so much you can do to assert your seniority with the chair, my friend—especially when he specifically chose her for his service out of three chiefs and three senior residents.

Start a new Sdn account.

Openly call out such attending and program in a new thread. Out of embarrassment the pos attending will be forced to apologize and forever allow you to operate as many cases as you wish.

On a more serious note
There will be favoritism everywhere my friend. It doesn’t stop here. There will be favoritism in your professional career against you. You’re gonna have to work around it. You’re smart enough.

 

[Ancient_amalgamator]

No, I get that bias is common. Even I have my own biases. But I believe it reaches a point where you simply cannot tolerate the bull**** anymore. If someone is favored because they work hard, perform well, and have earned the opportunities, I honestly could not care less. But this is a completely different level of favoritism and hypocrisy.
Regarding the new SDN account, i am contemplating LOL

 

[SilkyJ]

Are you the “fifth year or chief resident” that’s being passed over? I’ve certainly seen scenarios where people are completely oblivious to their own shortcomings and don’t understand why they’re getting the short end of the stick. I saw firsthand a couple residents that were “mistreated” by faculty that didn’t realize that their coresidents were running around behind the scenes correcting their mistakes every day. Or felt they should be given responsibility they plainly couldn’t handle. Could honestly be your faculty’s way of expressing their opinion about a certain senior/chief resident… or it could be simple favoritism. Impossible to say from the outside looking in. Regardless, opportunities are rarely handed out in a perfectly equal fashion. If you’ve raised your concerns and they don’t care, there’s probably a reason for that. Just do your best with what you’re given.

 

[upperlower]

This didn't really read like mistreatment complaint but thats an interesting take on the situation. It seemed more like the chairman being inappropriate and choosing a junior female resident to operate with over 6 other more senior residents.

I've seen your attitude develop amongst the lazy residents at mediocre programs though. When your not busy you need something to talk about. It's a group practice. Getting a page about your co-resident's patient when they are in the OR or seeing a post-op in your clinic isn't correcting their mistakes. You will have to step in and help sometimes and good residents don't complain about it.

Speak to faculty that have even a slight care about their job and the speciality and they will tell you they can train anyone to do it. The program should have a system in place that gets each resident abundant experience at each level of the program so residents aren't looking for handouts or unprepared for the next stage in their training.

 

[SilkyJ]

This didn't really read like mistreatment complaint but thats an interesting take on the situation. It seemed more like the chairman being inappropriate and choosing a junior female resident to operate with over 6 other more senior residents.

Agreed, but it’s kinda vague and I doubt if 6 senior residents together raised a concern that it wouldn’t be taken seriously. I just wondered if it was happening with all residents, or just the the OP. Kinda changes the dynamic if it’s just them.

I've seen your attitude develop amongst the lazy residents at mediocre programs though. When your not busy you need something to talk about. It's a group practice. Getting a page about your co-resident's patient when they are in the OR or seeing a post-op in your clinic isn't correcting their mistakes. You will have to step in and help sometimes and good residents don't complain about it.

Not a lazy resident, and not what I’m talking about. Yes, you work as a team to care for patients. I’m talking about admission orders constantly screwed up, balls being dropped all the time, unable to do a basic workup for patients, unable to handle routine care of floor patients; generally not able to function and follow through at an appropriate level for your year of training. It’s not a rare issue, every program has an underperforming resident somewhere.

Speak to faculty that have even a slight care about their job and the speciality and they will tell you they can train anyone to do it. The program should have a system in place that gets each resident abundant experience at each level of the program so residents aren't looking for handouts or unprepared for the next stage in their training.

It should be this way. Isn’t always.

 

[Ancient_amalgamator]

Agreed, but it’s kinda vague and I doubt if 6 senior residents together raised a concern that it wouldn’t be taken seriously. I just wondered if it was happening with all residents, or just the the OP. Kinda changes the dynamic if it’s just them.

Not a lazy resident, and not what I’m talking about. Yes, you work as a team to care for patients. I’m talking about admission orders constantly screwed up, balls being dropped all the time, unable to do a basic workup for patients, unable to handle routine care of floor patients; generally not able to function and follow through at an appropriate level for your year of training. It’s not a rare issue, every program has an underperforming resident somewhere.

It should be this way. Isn’t always.

Not everyone is confrontational. Some people simply bend over and take it, while others refuse to tolerate it. We are where we are now because this kind of behavior has been accepted and allowed to continue for far too long.

 

[Rush_motion]

Not a lazy resident, and not what I’m talking about. Yes, you work as a team to care for patients. I’m talking about admission orders constantly screwed up, balls being dropped all the time, unable to do a basic workup for patients, unable to handle routine care of floor patients; generally not able to function and follow through at an appropriate level for your year of training. It’s not a rare issue, every program has an underperforming resident somewhere.

This doesn’t pertain to the OP. The OP is a senior resident. They don’t do the b!itch work you just described. That’s done by lower residents. Senior residents also don’t get pimped as much during rounds. The pimping is mainly targeted towards the lower residents. Most of their ‘mistakes’ are long forgotten by the time they reach senior level.
This seems like a legit case of favoritism which I don’t know why you can’t sympathize with the OP.

Reading the OPs post reminds me of dental school the very first week. An upper level dental student told me very clearly: Rush… if you want to have an easy time in d school and have faculty support do the following : grow a set of tits and start wearing lipstick

 

[BestInHere]

"Reminds him of his daughter"- is that code word of him wanting to bang her?

 

[Rush_motion]

Not everyone is confrontational. Some people simply bend over and take it, while others refuse to tolerate it. We are where we are now because this kind of behavior has been accepted and allowed to continue for far too long.

What you described is correct behavior. Well done.
Keep your mouth shut.
Before you try to stand up and be a hero to your chairman do a search on SDN under BYU4U. Read all the threads he created trying to match to a program after he got kicked out. Do you think it’s fun to email and call every receptionist from every program?
I know I’m exaggerating but I’m also not. No one cares including you (eventually) about these few cases your attending is not letting you cut.

 

[enucleator]

Agreed, but it’s kinda vague and I doubt if 6 senior residents together raised a concern that it wouldn’t be taken seriously. I just wondered if it was happening with all residents, or just the the OP. Kinda changes the dynamic if it’s just them.

Not a lazy resident, and not what I’m talking about. Yes, you work as a team to care for patients. I’m talking about admission orders constantly screwed up, balls being dropped all the time, unable to do a basic workup for patients, unable to handle routine care of floor patients; generally not able to function and follow through at an appropriate level for your year of training. It’s not a rare issue, every program has an underperforming resident somewhere.

It should be this way. Isn’t always.

Ok lazy ass. I haven’t seen an intern past the first 6 weeks that couldn’t do this. Only one and she did three non cats because the chair really liked her. If you assign all the work to the hard working residents all that will be left is the clean up crap and yah you will be bitter.

 

[SilkyJ]

This doesn’t pertain to the OP. The OP is a senior resident. They don’t do the b!itch work you just described. That’s done by lower residents. Senior residents also don’t get pimped as much during rounds. The pimping is mainly targeted towards the lower residents. Most of their ‘mistakes’ are long forgotten by the time they reach senior level.
This seems like a legit case of favoritism which I don’t know why you can’t sympathize with the OP.

Reading the OPs post reminds me of dental school the very first week. An upper level dental student told me very clearly: Rush… if you want to have an easy time in d school and have faculty support do the following : grow a set of tits and start wearing lipstick

It’s not that I can’t sympathize, I just wanted to know if all seniors are getting the shaft, or just the OP with just that particular faculty. I’ve seen residents who underperformed as junior residents, and the dynamic carried into their later years, where they were scrutinized much more closely, got crapped on by faculty routinely, and didn’t receive equal opportunities to their coresidents. Not saying it’s fair or right, just what I’ve seen.

I absolutely agree that keeping your head down is a wise move. I’ve never seen a resident stand up to attendings and have it go anything other than poorly. If this is a legit case of random favoritism, then there’s likely nothing you can do about it, without exposing yourself to some risk that won’t be worth the fight.

It would be nice to get some more specific details, but I understand the OP is nervous about outing themselves. Totally fair.

 

[Rush_motion]

My best advice to the OP - and really this is to ALL rising Chief residents.

When I was in my administrative chief year, I created an excel sheet.
The intention was to create as fair of a distribution for all surgical cases among the chief residents as humanly possible.
Trauma, orthognathic, path and recon, tmj, you name it.
Any surgical cases had to be distributed equally and fairly.
This also meant that attendings would be categorized and distributed fairly with respect to caseload distribution (the best attendings that allowed a case to be fully operated on by a resident was worth way more than an attending that was hands on etc).

If among the chief residents there was a case where a certain attending would request a certain chief resident for whatever reason… none of us would take offense because it would get logged and the next time a case of that nature was ready to go, the other chief residents would be in line for that case. It creates and open and transparent system.

If it happens with a junior resident, and the chair… that’s more of a unique scenario.
I have never encountered this myself.

 

[upperlower]

What you described is correct behavior. Well done.
Keep your mouth shut.
Before you try to stand up and be a hero to your chairman do a search on SDN under BYU4U. Read all the threads he created trying to match to a program after he got kicked out. Do you think it’s fun to email and call every receptionist from every program?
I know I’m exaggerating but I’m also not. No one cares including you (eventually) about these few cases your attending is not letting you cut.

Yes do not try to be a hero, no matter how complacent, vindictive or inappropriate their decision making is. I think this is obvious from the moment you enter into one of these programs. Some of these chairman were given the position because there was no alternative, not because of their proven track record or leadership skills.

An attending that can actually do the whole specialty is rare so good luck surviving their wrath as a resident. There is no obligation for the program to teach you. All that stuff in the your program handbook about counseling and remediation is a fairy tail and the hospital will not expect that they have done any of that.

 

[nade0016]

PD here, you need a sit down with the PD/Chair of your program and express your concern. If they are good people, they will listen to your side, then they will give you their side of the situation. As always, there are three side to every story, yours, theirs and the truth. Best case scenario is the faculty is not conscious of the issue and will course correct. Worst case scenario is that you have made the faculty aware that you have noticed or felt the bias. After the meeting send a follow up email (to get things in writing) expressing thanks for the opportunity to discuss a difficult topic. Then, if nothing changes you have the ability and evidence to take it to the next level. Should you wish. But that could also have unintended consequences.

 

[Rush_motion]

After the meeting send a follow up email (to get things in writing) expressing thanks for the opportunity to discuss a difficult topic.

lol
To the OP : tread carefully.
Is it really worth upsetting your chair over a few cases ?

Maybe it’s just me but there is a better way to attack and handle this matter.
Show up to your chairs clinic and see all his consults with him and write all his notes as opposed to the intern who will rush through everything and write notes with a ton of mistakes. Show interest in his surgical consults and post ops. Keep talking to your chair about his upcoming cases and surgical plan. Keep asking what surgical approach he will take etc etc and then ask him can I do it ? Keep phoning him personally every night to update him on his patients that are in house.

Bro unless he is an absolute pos (which I’m sure he is) he will let you cut his cases.

 

[upperlower]

Both of these arguments have merit but you may already be expected to write your chairs notes and have no choice which clinic you are assigned. If you can go to a program where the chair will speak to you on this level go there but mostly there will be some gate keeping chief resident in between you. For that matter, most of the attendings are gate keeping also and don’t want to answer your questions about surgery either.