There are only two things that make one learn during medical school clinical rotations: pimping, and variety.
If you never get asked questions, there's no incentive to learn. If you see a variety of different cases, and are pimped thoroughly on all of them, you will learn that material. In fact, you will probably read up on and learn things that you don't see as well, in anticipation of being pimped on them. If you see the same thing over and over again, is there any value in that? If you're learning to do the procedure, sure there is. If you're a medical student, there's no value whatsoever.
Case in point: doing my ENT elective, I saw and scrubbed on a different case pretty much every day. The chief and attending pimped me from time to time, sometimes they didn't, sometimes they did, but I always tried to read up on the casese I was doing tomorrow so that I wouldn't look like an idiot. And so I learned a whole lot of stuff, way more than I expected to in 2 weeks.
Now for 8 weeks of surgery, pre-rounding on patients at 4:30 in the morning, asking them the same questions, if they farted, walked around, etc. so that I can get my notes done so that I can look hardworking in front of the resident - is there any educational value in that? Sure, to an extent. These are necessary skills, to learn the basic post-op course for a patient. But after you've done it for a day or two, there's no further learning in it. You're helping out the team, so that feels good, but you're definitely not learning a damn thing.
You've seen three lap appys, you've seen them all. If you're going to be a general surgeon, then yes, you need to see all the possible variants of anatomy, and all the possible complications of a given procedure. But as a medical student, you just need to get a general idea, to see if that's what you want to end up doing with your life. It's fine that surgery tends to be a malignant rotation -- that's the tradition of the field, and that's accepted and that's the way it will stay. But it really comes down to you guys, the residents. Ask the med students questions, ask them WHAT THEY WOULD DO if THEY were the resident. That's how we learn. That's what the point of this whole exercise is, not to see who wakes up the earliest or stays the latest for the sake of waking up earlier or staying later.
Hey goremachine, thanks for posting an interesting comment. The first thing that comes to mind reading your post is that, and this is an educated guess here, your chief/senior residents sucked pretty bad on gen surg. Maybe not pretty bad, but really bad, like Sara Palin bad
There's a lot of opinion, fact, and impression in your post, and I'm not going to tease out everything line by line, but a few points are worth commenting on.
You compare being in the OR on ENT with rounding on the floor on gen surg (paragraphs 2 and 3, and if this was not your intent, then you just wrote your comment poorly), and I understand the point you are trying to make, but I think it could be made better. Let me explain. Your experience in the OR on ENT, being pimped occasionally, was positive. Yet you do not describe any comparable experience in the OR on gen surg. I would bet that if a gen surg attending pimped you during a case it would also be a good experience. Similarly, if you were to round on your ENT post-op patients everyday, asking them if they can see, hear, feel, swallow, doing the same neuro exam over and over and over and over, you would probably also say "is there any educational value in that?"
The point of doing the exam over and over and over and over is not to torture, to write a note, to waste time, etc, but to 1) see if your patient is progressing as expected and, probably more importantly, 2) discover complications. Do you know how your patient is supposed to progress? if not. ASK. Do you know what the post-op complications are and how they present? if not. ASK. Any med student who thinks that they are the only ones who care about the vitals and lab values are sorely mistaken: the initial non-op splenic lac that bleeds out on hospital day 3 and needs their spleen out; their vitals/labs may have been stone cold normal for the first 2 days (i.e. boring). The morbidly obese post-op lap gastric bypass that, previously fine, now has a low grade fever and is slightly tachpneic (i.e. disaster pending). This is why you ask the same questions over and over.
I absolutely agree that med students are supposed to get a 'general' idea of what surgery is like. There is an important point in here: 'general', to most residents and attendings, is intended to mean brief and (most) likely limited, but DEFINATELY not less intense. I believe this is where a lot of resentment, discontent between students/residents/attendings occurs. If a student is on a particular service for, lets say just 2, or even 4, weeks, the residents and attendings, expect that the student is completely, utterly, totally, involved in the service during that time. Anything less, is, well, not 'honors' work. The medical school administration should provide students with enough time to study, over the course of the rotation, to do well on a shelf exam. This NEVER substitutes for learning about a particular case on a particular patient on a rotation.
I completely, wholeheartedly agree with goremachine that residents need to be actively involved in teaching, actively teaching, their med students.
