Mar 30, 2010
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Has anyone else attended this course? I am at the ACS this weekend and so far it has been excellent. I'm sure there are times when we all struggle with taking the time to teach our medical students/junior residents. With all of the extraneous tasks we have to complete on a daily basis, in addition to becoming competent surgeons, education can become an afterthought. I would be interested to hear about anyone's experience with this course and how it has helped you as a teacher. :cool:
 
Mar 30, 2010
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Okay, so I'm high jacking my own thread. let's share some funny educational stories. I once was the junior resident when the following "educational moment" took place in one of our clinics

Intern: Dr. X (surgical oncologist) I have a patient with a 2cm x 1cm melanoma on his back. I took a history and my physical exam shows no other areas of concern.

the interns are scared of this attending

Dr. X: did you look at his B#$s (insert scrotum)

Intern: well....... No sir

Dr. X: Really!!! does he have skin on his [email protected]#s (again insert scrotum)

I'm behind the attending crying laughing at this point

In the next scene the intern has returned to the exam room and has the patient strip naked so that he and the attending can complete the exam.:laugh:
 

JackADeli

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Has anyone else attended this course? ...we all struggle with taking the time to teach our medical students/junior residents. With all of the extraneous tasks we have to complete on a daily basis, in addition to becoming competent surgeons, education can become an afterthought...
I have not attended the course. However, I did want to post some thoughts on this topic.
1. Just graduating medical school and/or residency does not make one a good teacher. Too many folks graduate with these examples (residents/attendings) and then believe they have learned to be teachers. Given that, I encourage folks to actually learn true teaching skills. Maybe this course provides that? But, we currently have a sytem that often fails to employ modern teaching techniques and/or understandings of how "adult learners" learn.
2. I encourage residents to teach if for no other reason then to use it as a tool to increase one's own self learning. However, the resident as a teacher seems too often a maneuver for programs to dump responsibility for teaching. Too many programs want resident "coverage" or "service" but are very lacking in any beneficial teaching. And, as to #1 above, most (attendings/faculty) have little to no formal training in education. Maybe through the course, future attendings will have a better grasp of how to teach. But currently, residents are often left to "self-learn" the lion share, of what they are suppose to learn in residency, all on their own.
 

glade

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Point #2 is spot on. We're always told that "you're in a training program and therefore part of your responsibilities is to educate those who are junior to you, including medical students." Meanwhile, nobody is educating me (or anyone below me) in any coherent fashion. That's why, as a mini-hijack and with the understanding that there are a few of these threads already floating out here, I scoff at people who are terrified of the 80- or 60- or 40-hour work week.

This is probably my last post on here (by choice), so I'll just unload. The two reasons most often given for the dogma of the time spent in the hospital are prolonging the length of training and simply tradition. Those who are against shortening the work week say that it would result in requiring additional years of training. Hardly. There seems to be a confusion between what is beneficial and what is not. In other words, we are trained to reflexively view most anything as "our duty." When I do discharge summaries, I am constantly told that "this is something you will do for the rest of your life." I guess, except that none of my attendings has done a discharge summary for the past twenty years since they have the residents doing them all for them. Clearly, a discharge summary is not "scut," but just as clearly it has zero educational value. I've been on services where I sat around doing discharges (writing prescriptions, making appointments, dictating reports, calling other services to make sure they are OK with the discharge) for the better part of the entire morning, literally four or five hours. To say that this benefitted my surgical training in any way, that is, made me a better surgeon, is really a farce. The truth of the matter is, there are lots of things we do as residents that have no benefit whatsoever to our training. The reality is that we do it because someone has to. Ever seen a day where the residents have to take time off, like for the ABSITE? Know why they do it on a weekend? Because if the ABSITE were on a weekday, it would be utter chaos. Our attendings literally don't know how to even input orders half of the time because they're so used to just saying to residents something like "get IR to drain that abscess." To them, a discharge is "discharge the patient." Clearly it hasn't negatively impacted them that they don't do these activities. There is no arguable reason that shortening the work week would necessitate an increase in the training period, other than the fact that most of the major hospitals in America depend on residents to stay operational.

The second reason is "tradition," which is basically a belief that if you don't put up with the same B.S. that they did in 1920 then you're a "lesser" surgeon, de facto. The surgical training program used to be pyramidal and we constantly hear stories of how the chaff fell through and only the creme de la creme survived. And yet, I bet we all know surgical attendings from that era with questionable surgical skills and who make horrendously poor decisions. I know I do. I am constantly amazed because apparently their only redeeming feature was the ability to tolerate long work hours and that qualified them to be "master surgeons." We need to get over this self-imposed foolishness.

Take care, everyone, I'm out like the Godfather.
 

JackADeli

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...In other words, we are trained to reflexively view most anything as "our duty."...

The second reason is "tradition," which is basically a belief that if you don't put up with the same B.S. that they did in 1920 then you're a "lesser" surgeon, de facto. ...We need to get over this self-imposed foolishness...
Agreed. I would also add, as it has come up in other threads, it seems numerous attendings/PDs training in "educating" residents is geared towards actually "controlling" residents. Thus, "punitive psychiatry" evaluations of "trouble makers". It's is quite interesting how the "resident as teacher" mantra has become such a wonderful catch phrase.... most residents swallow-up.

I say, yes, learn to be a "real teacher". But, don't assume the responsibility at the expense of what your real purpose for being there (residency) is.... i.e. trainee, aka "student". Reminds me of the grad schools in which the PhD hasn't actually taught a class in a long time.... that's what they have grad students for:scared:
 

Amgen1

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When I do discharge summaries, I am constantly told that "this is something you will do for the rest of your life." I guess, except that none of my attendings has done a discharge summary for the past twenty years since they have the residents doing them all for them. Clearly, a discharge summary is not "scut," but just as clearly it has zero educational value. I've been on services where I sat around doing discharges (writing prescriptions, making appointments, dictating reports, calling other services to make sure they are OK with the discharge) for the better part of the entire morning, literally four or five hours.
spend some time in a private practice environment (where the majority of medicine is practiced). Private practice surgeons write and dictate their own consults, H&Ps, admit notes, clinic notes, discharge summaries, orders, etc. The reality is this is what you are going to be doing the rest of your life if you are in a private practice. Even in many academic environments many attendings will do all of these things on their own (occurs increasingly more as residents get spread thin with the 80 hr work week)
 

glade

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I knew that someone would bring that up. Absolutely. Clearly, there are a lot of surgeons who practice outside of residency training programs. Like I said, doing that stuff is not "scut." It's just not educational. It's like saying you're responsible for putting in every Foley in the hospital over five years because you should know how to do it. I don't deny that there is a need to know how to do a discharge summary. I do, however, find it silly that we do it and 1) nobody shows us how, leaving us to fumble through it ourselves, 2) nobody reads it ever, including the attending who supposedly is there to oversee it, and 3) the attendings lecturing us on the need to do it never do it, even if their private practice counterparts do.
 

JackADeli

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...Private practice surgeons write and dictate their own consults, H&Ps, admit notes, clinic notes, discharge summaries, orders, etc. The reality is this is what you are going to be doing the rest of your life if you are in a private practice...
...Clearly, there are a lot of surgeons who practice outside of residency training programs. Like I said, doing that stuff is not "scut." It's just not educational. ...nobody shows us how, leaving us to fumble through it ourselves, ...nobody reads it ...who supposedly is there to oversee it..
Residency can continue on as it has in many ways for a very, very long time. It does not mean it is the best way to educate or train. It does come down to what is "service over education".... As noted in this thread and others before it and probably after it, "we" imprison ourselves in thoughts of duty, obligations, being "old school" and "hardcore"... if "we" choose to do so. The real truth is "we" will never be the trainees of years past. That system is gone. It is no longer the pyramid your attendings remember. There actually is a such thing as an "ER/EM" residency. We actually have ICU specialists with ICU equipment, etc/etc... "We" can continue to kill ourselves to prove we are the cowboys of years past and in doing so will actually sacrifice our learning. I have seen too many the attendings/PDs turn on the resident after he/she bends/breaks the rules. The attending, "I never asked you to do it.... you lied about your hours.... you chose to endanger the program... etc...". Residents allow the mirage of glory days and guilt tripping to allow themselves to choose these things.

Again, ask yourselves... who is actually teaching you all these things? The "residents as teachers & leaders".... who taught them? How far is your education from the original lesson? Much like the degraded xerox copy made from a copy of a copy of a copy... But, things have long since past the original management education moment.

The senior attendings do have much to teach... but "we" have much to learn beyond what they learned decades ago. Sit down and speak with the senior "inguinal hernia guy" in your program. It amazes me when you ask about breast cancer or ICU management. They have some good stories to tell.... some of them had "gased" garden hoses for chest tubes in their day. Their defibrillators WERE the big cart ours are on now. They had range wars like the Lee & Peacock down in the ED. The ED used to be staffed by medicine, surgery and pyramid-out former surgery residents, etc/etc....

There is plenty to learn. It is just a matter of will residents of today/tomorrow and attendings of today/tomorrow move forward or try and hold-on to something that is no longer there? Unfortunately, numerous universities hold on to the past.... they are not the leaders, rather followers. Look at laparoscopy/lap choles as one example. Who led that revolution????
 

midway

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Attended the conference in 2008, lots of "touchy feely" ****, sitting around a table singing Kumbaya in groups talking about "what type of leader are you?" and stressing the importance in teaching students and getting them involved. It was great to be away from the hospital and in Chicago for 2 days, but the course was worthless, in my opinion. I recommend to save your conference time/money for something worth while. (ie. Vegas Trauma Conference in March!)