Residents, why do you make us scrub when you know it's crap

[Manual Disimpaction]

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Walk into the case I was assigned to today and see an attending, fellow, two residents who are all scrubbing in to work on small area of the body. I notice all the bodies and ask if they would still want me to scrub in. They all insist that I scrub because "this will be a good experience for you". So I go over and scrub in for the 152nd time in my life.

Spend the next 6 hours standing at attention in that sauna suit of a gown staring at 4 backs.

Not the first time it's happened to me though so I'm wondering if residents truely think getting all squeaky clean and standing there 7 feet from the surgical field is educationally beneficial?

 

[Señor S]

I always hated this. I'm taller than 90% of people and still couldn't see anything most of the time. Total waste.

Like a lot of things in medicine it comes down to "we had/have to do it, so you should too."

 

[sazerac]

Did you get to sew up the patient at the end?

 

[Manual Disimpaction]

Did you get to sew up the patient at the end?

No I got to stand there with a thumb up my ass while they did though

 

[sazerac]

No I got to stand there with a thumb up my ass while they did though

Well, that explains your username then.

 

[sliceofbread136]

That's surgery for you! If you get really lucky they'll let you drive the camera making that 100 hour week totally worth it!

Absolute waste of time

 

[zeppelinpage4]

Hmm...from my experience, I was usually pretty happy when they let me scrub in, even on the cases where I just stood there and watched without doing anything. Different strokes I guess.
When I couldn't scrub in, I'd have to awkwardly stand in the corner of the room with the scrub nurse and look at everyone's backs for 3 hours.
Even if I didn't do anything, if I got to scrub in, I could at least see a bit of what was going on and ask questions.
Also, the ORs were REALLY cold, and I just liked being wrapped up and warm when scrubbed in during a case. 😛

Of course, if it was too crowded and I wouldn't see anything even while at the table, they'd tell me not to scrub in. Sounds like in your case they might have had you scrub in, even on the crowded cases where you couldn't even get close to the table while scrubbed.
In that case, I understand your frustration. If you're not gonna at least see what's going on while scrubbed, then it's better to stand away from the table and have the ability to scratch your nose/sit down/take bathroom breaks.

 

[Fundamentals]

feel the exact same, such a waste of time. would gain 50x more being able to read something for 3 hours than scrub for surgeries like that

 

[Goro]

Where's the wise @SouthernSurgeon when you need him???

Walk into the case I was assigned to today and see an attending, fellow, two residents who are all scrubbing in to work on small area of the body. I notice all the bodies and ask if they would still want me to scrub in. They all insist that I scrub because "this will be a good experience for you". So I go over and scrub in for the 152nd time in my life.

Spend the next 6 hours standing at attention in that sauna suit of a gown staring at 4 backs.

Not the first time it's happened to me though so I'm wondering if residents truely think getting all squeaky clean and standing there 7 feet from the surgical field is educationally beneficial?

 

[SouthernSurgeon]

Where's the wise @SouthernSurgeon when you need him???

That many learners scrubbing in is a crappy learning environment.

While I feel bad for the student, I feel worse for the residents who are apparently triple scrubbing with a fellow.

 

[neusu]

Part of the surgery clerkship, historically, has been the pain of being scrubbed and not able to see or do anything. In the future, given the shift towards trying to make students happy all of the time, this may be a relic of the past.

 

[Doctor-S]

No I got to stand there with a thumb up my ass while they did though

Oh my gosh, this is a hilarious comment and made me laugh and smile - loved it! 🙂

 

[mimelim]

Unless it is an open belly case, I'm not going to double scrub a case. I think that it is reasonable for medical students/interns/maybe second year residents to double scrub virtually all of our cases. I don't think I would ever have anyone quadrupal scrub a case unless we were operating in multiple areas (ie. poly trauma). It is a waste of time.

I am astounded at how little some schools let their students do. If I have a simple wound washout/debridement the medical student should expect to hold the bovie the entire case. They should expect to close all the skin and do half of the deep dermals, etc. As long as my attending isn't standing there waiting for us to finish quickly, I couldn't care less. Now, on the other hand, if it is obvious that you have never held a needle driver or hold your forceps like a soup spoon or tied knots before, I'm going to take it away from you. You have plenty of time as a student to practice those things, I don't mind guiding your technique on my patient, but you aren't learning things that can be easily learned on plastic. Hopefully your school has didactics or teaching sessions and if not, there are plenty of websites/youtube for it.

 

[jw3600]

Part of the surgery clerkship, historically, has been the pain of being scrubbed and not able to see or do anything. In the future, given the shift towards trying to make students happy all of the time, this may be a relic of the past.

Are you insinuating that not making students scrub in for cases where they don't do **** is just catering to the milennials? Just seems logical and considerate to me.

 

[SouthernSurgeon]

Unless it is an open belly case, I'm not going to double scrub a case. I think that it is reasonable for medical students/interns/maybe second year residents to double scrub virtually all of our cases.

I'm amazed by how few of our junior residents see/understand the value for them to double scrub.

For one, it means exposure to some big cases they wouldn't otherwise see at all during intern year.

For another, at the very least the attending is going to scrub out and let them close the belly with me. Learning to close fascia is valuable for the juniors and every rep counts.

Finally, the more they show up, the more the attendings get to know/trust them. The staff will let me take them through bowel anastomoses or mobilizing, getting the case set up, once they have some base level of comfort with the interns' skill level.

 

[VisionaryTics]

I'm amazed by how few of our junior residents see/understand the value for them to double scrub.

For one, it means exposure to some big cases they wouldn't otherwise see at all during intern year.

For another, at the very least the attending is going to scrub out and let them close the belly with me. Learning to close fascia is valuable for the juniors and every rep counts.

Finally, the more they show up, the more the attendings get to know/trust them. The staff will let me take them through bowel anastomoses or mobilizing, getting the case set up, once they have some base level of comfort with the interns' skill level.

Same. I don't get it. Some of our juniors will be like "peace out, I'm going to call room" if they're not primary surgeon on a neck dissection or thyroid. Whatever, I'm not the chief.

To get back to med students, it's up to the residents to guide med students to ORs where they will learn something. Learning something could be learning how to suture or it could be seeing a rare procedure (even if it means standing there uselessly for a few hours).

 

[giantswing]

It's so you can figure out if you like surgery or not, which is what third year is for.

Seriously. As a medical student you have three jobs: learn medical stuff, learn what you want to do as a grown up, and don't create more work for your resident or attending. Mostly the last one.

 

[Stagg737]

It's so you can figure out if you like surgery or not, which is what third year is for.

Seriously. As a medical student you have three jobs: learn medical stuff, learn what you want to do as a grown up, and don't create more work for your resident or attending. Mostly the last one.

Good advice, but I don't see how staring at backs and not seeing any of the actual surgery helps accomplish any of the three things you mentioned, and standing there doing nothing and seeing nothing for 4 hours would only make most people hate that rotation. Unless everyone legit thought OP would get to do something, it's seems pointless to make him scrub in on that case.

 

[Doctor-S]

... the more they show up, the more the attendings get to know/trust them.

... and be more willing to introduce/include them in actual procedures because we're growing more familiar with them, and with their level of knowledge/dedication/skills ... and we look forward to having you as a working professional colleague, and not turn you into a catatonic statue in the OR with your pollex vertically inserted into your you-know-where! <s>

 

[Ismet]

Unless it is an open belly case, I'm not going to double scrub a case. I think that it is reasonable for medical students/interns/maybe second year residents to double scrub virtually all of our cases. I don't think I would ever have anyone quadrupal scrub a case unless we were operating in multiple areas (ie. poly trauma). It is a waste of time.

I am astounded at how little some schools let their students do. If I have a simple wound washout/debridement the medical student should expect to hold the bovie the entire case. They should expect to close all the skin and do half of the deep dermals, etc. As long as my attending isn't standing there waiting for us to finish quickly, I couldn't care less. Now, on the other hand, if it is obvious that you have never held a needle driver or hold your forceps like a soup spoon or tied knots before, I'm going to take it away from you. You have plenty of time as a student to practice those things, I don't mind guiding your technique on my patient, but you aren't learning things that can be easily learned on plastic. Hopefully your school has didactics or teaching sessions and if not, there are plenty of websites/youtube for it.

Aw man I never got to hold the bovie. 🙁 On plastics I got to close a lot, washed out wounds, did liposuction, assisted with flaps and reconstructions...it was great. On peds surg we were largely ignored except for a couple attendings who actually spoke to us, I usually retracted for them which was fine, never closed or anything else, and our main purpose was being number monkeys in the morning.

 

[mimelim]

Aw man I never got to hold the bovie. 🙁 On plastics I got to close a lot, washed out wounds, did liposuction, assisted with flaps and reconstructions...it was great. On peds surg we were largely ignored except for a couple attendings who actually spoke to us, I usually retracted for them which was fine, never closed or anything else, and our main purpose was being number monkeys in the morning.

Honestly the biggest thing is, can I get us out of the mess if the student ****s it up? If the answer is yes, in general I'm mostly for letting the student struggle. In the case of suturing, it is all about control. If they have good control of their needle and suture well, they can do whatever we have time for. If there is nothing dangerous nearby to hurt, there isn't much that a student can't do with guidance. Even when it backfires, for example last week when the MS4 that was closing deep dermals stabbed the fistula with their 3-0 PDS, it is a learning point and isn't a hard fix.

EMRs are making numbers monkeys less necessary. Which is a good thing 😛.

 

[Ismet]

Honestly the biggest thing is, can I get us out of the mess if the student ****s it up? If the answer is yes, in general I'm mostly for letting the student struggle. In the case of suturing, it is all about control. If they have good control of their needle and suture well, they can do whatever we have time for. If there is nothing dangerous nearby to hurt, there isn't much that a student can't do with guidance. Even when it backfires, for example last week when the MS4 that was closing deep dermals stabbed the fistula with their 3-0 PDS, it is a learning point and isn't a hard fix.

EMRs are making numbers monkeys less necessary. Which is a good thing 😛.

Yeah I could understand why we didn't get to do much on peds surg, but it was just really disappointing with how little or no attention was paid to us or our learning. This was drastically different from my time on plastics, where seemingly all of the residents, fellows, and attendings really loved to teach and get us involved. I was apparently a fast learner and good with suturing so they let me close almost everything early on, and I watched and/or helped with a lot of really neat cases.

Still had to calculate urine output in cc/kg/hr for all like 60 of the peds surg patients every morning 😛 Wish the EMR could just calculate that for us!

 

[jw3600]

To get back to med students, it's up to the residents to guide med students to ORs where they will learn something. Learning something could be learning how to suture or it could be seeing a rare procedure (even if it means standing there uselessly for a few hours).

I think mainly everyone agrees with you. I would gladly stand and watch for hours if I can do a few things here or there: retract, close, cut sutures, apply dressings, etc. Even if it's just scrubbing to be close enough to look into the field. But I don't want to stand behind 4 gowned people for hours if I will literally do nothing AND can't see a single micron of the field. If you know it's gonna be like this just let us observe and we will scrub in on the next one when there's more of a chance.

 

[mehc012]

It strikes me as odd when, as a first year student, I get a much better perspective than the M4s who are doing their sub-Is and are expected to scrub in. They end up standing next to the resident, far away from the surgical site, and if they're lucky enough that there's a monitor, they usually have to crane their necks awkwardly to watch it. I end up just behind the curtain, with a clear, direct view of the incision, the monitor in front of me, able to hear everything the attending says to the resident and to ask questions. Sure, the M4 occasionally gets to throw some irrigation in when prompted, but that honestly just means they can't turn to watch the monitor anymore. I'm not knocking it - I ended up talking through this with at least one of the students on their sub-I, and it's just a part of the progession you go through in medical education - it just makes me want to see more of these specialties now while I have my best view.

 

[Mad Jack]

Given that I'm physically incapable of being a surgeon, this rotation will no doubt be a blast. At least I'll get an appreciation for the flow of things I guess. And I'll learn how to suture decently well, a skill I will no doubt utilize daily as a psychiatrist (really though, it'll be nice to have a basic skill for when someone gets ****ed up while hiking with me or whatever).

 

[Stagg737]

It strikes me as odd when, as a first year student, I get a much better perspective than the M4s who are doing their sub-Is and are expected to scrub in. They end up standing next to the resident, far away from the surgical site, and if they're lucky enough that there's a monitor, they usually have to crane their necks awkwardly to watch it. I end up just behind the curtain, with a clear, direct view of the incision, the monitor in front of me, able to hear everything the attending says to the resident and to ask questions. Sure, the M4 occasionally gets to throw some irrigation in when prompted, but that honestly just means they can't turn to watch the monitor anymore. I'm not knocking it - I ended up talking through this with at least one of the students on their sub-I, and it's just a part of the progession you go through in medical education - it just makes me want to see more of these specialties now while I have my best view.

Keep in mind this is not something that is necessarily typical of all locations/programs. Sure it exists, and maybe it's even common, but there've already been plenty of times as an MS3 that I've gotten to be first assist and I've probably done some things that some people (maybe most) won't get to do until residency. I think it really varies a lot from school to school and from program to program.

 

[mehc012]

Keep in mind this is not something that is necessarily typical of all locations/programs. Sure it exists, and maybe it's even common, but there've already been plenty of times as an MS3 that I've gotten to be first assist and I've probably done some things that some people (maybe most) won't get to do until residency. I think it really varies a lot from school to school and from program to program.

No, I mean...they got to help close and things like that, and with the kinds of cases I was watching (pediatric neurosurgery) it was perfectly understandable that they were limited in what they could help with during the crux of the dissection. It just struck me how they were 'allowed' to scrub in despite that those who were not scrubbed in could get a far better view and had a better ability to ask questions for the first several hours of each case. For what it's worth, I think my program is actually very good about making students feel included and making sure they participate. It's just that they are also very good about making observation as valuable an experience as possible - even factoring in the presence of observing students when deciding whether to use the microscope, for example - and often there's more to work with on that front.

 

[giantswing]

Good advice, but I don't see how staring at backs and not seeing any of the actual surgery helps accomplish any of the three things you mentioned, and standing there doing nothing and seeing nothing for 4 hours would only make most people hate that rotation. Unless everyone legit thought OP would get to do something, it's seems pointless to make him scrub in on that case.

You don't want to do surgery, so you wouldn't get it and I can't be bothered to explain.

 

[Stagg737]

You don't want to do surgery, so you wouldn't get it and I can't be bothered to explain.

I'm still considering fields that are relatively surgery heavy, but unless you're trying to kiss a**, can see what's being done on a monitor, or are getting pimped/instructed by an attending or resident, I really don't see the point of standing there with my "thumb up my a**" and doing literally nothing for 4 hours like OP did. I also fail to see how OP's experience is reflective of what being a surgeon is like or how that is a good learning environment for someone going into surgery.

 

[Ismet]

You don't want to do surgery, so you wouldn't get it and I can't be bothered to explain.

You however could be bothered to make this post? I'm sure whatever explanation you have isn't so terribly complicated that someone not interested in surgery couldn't understand.

 

[Bancrofti]

Same. I don't get it. Some of our juniors will be like "peace out, I'm going to call room" if they're not primary surgeon on a neck dissection or thyroid. Whatever, I'm not the chief.

To get back to med students, it's up to the residents to guide med students to ORs where they will learn something. Learning something could be learning how to suture or it could be seeing a rare procedure (even if it means standing there uselessly for a few hours).

As I finish up away rotations and get closer to matching, I wondered why junior residents would ever always volunteer to double scrub. On one of my aways a PGY2 was always there literally not doing anything until closing. I HATE the student experience now where if there is more than 1 physician scrubbed I'm basically relegated to suctioning or whatever else I can get my hands on to feign interest.

I suppose I can see what the other person just said.. learning how to close fascia is a crucial skill, so I can understand going. Personally though, (and I do love being in the OR) I would rather be studying or handling floor work than twiddling my thumbs watching a case "for the experience." There are other ways to learn and become a better physician/surgeon than to stand around. I've been in 8-10 hour cases where the time flies by, because I'm actively involved. I've been in 3 hour cases, not doing anything, that make me want to shoot myself, even if the case itself is something interesting.

 

[SouthernSurgeon]

As I finish up away rotations and get closer to matching, I wondered why junior residents would ever always volunteer to double scrub. On one of my aways a PGY2 was always there literally not doing anything until closing. I HATE the student experience now where if there is more than 1 physician scrubbed I'm basically relegated to suctioning or whatever else I can get my hands on to feign interest.

I suppose I can see what the other person just said.. learning how to close fascia is a crucial skill, so I can understand going. Personally though, (and I do love being in the OR) I would rather be studying or handling floor work than twiddling my thumbs watching a case "for the experience." There are other ways to learn and become a better physician/surgeon than to stand around. I've been in 8-10 hour cases where the time flies by, because I'm actively involved. I've been in 3 hour cases, not doing anything, that make me want to shoot myself, even if the case itself is something interesting.

I disagree completely. There is a ton of benefit as a junior in just showing up to the OR. I outlined several of them above.

You also learn a ton by passive modeling. You don't even realize it's happening, but you pick up a lot of things like how to handle the bowel, how the senior resident or attending holds the instruments at different points in the case, familiarizing yourself with various equipment.

Especially for bigger cases that just don't come around that often. There is no substitute for volume.

And as mentioned - the more you show up, the more they let you do. I've done total colectomies with a second year resident without the attending scrubbing in. That wouldn't happen if the attending wasn't comfortable with both me and the junior.

 

[evilbooyaa]

The difference is that when you're a resident, watching a 3 hour case IS studying.

 

[VisionaryTics]

As I finish up away rotations and get closer to matching, I wondered why junior residents would ever always volunteer to double scrub. On one of my aways a PGY2 was always there literally not doing anything until closing. I HATE the student experience now where if there is more than 1 physician scrubbed I'm basically relegated to suctioning or whatever else I can get my hands on to feign interest.

I suppose I can see what the other person just said.. learning how to close fascia is a crucial skill, so I can understand going. Personally though, (and I do love being in the OR) I would rather be studying or handling floor work than twiddling my thumbs watching a case "for the experience." There are other ways to learn and become a better physician/surgeon than to stand around. I've been in 8-10 hour cases where the time flies by, because I'm actively involved. I've been in 3 hour cases, not doing anything, that make me want to shoot myself, even if the case itself is something interesting.

Because there's a ton to learn. The way you'll do cases with each attending is different than you'll read in textbooks, so it helps to actually be second assist and see how to do it.

You don't learn surgery by showing up to every case expecting to be primary surgeon and saying to the senior/attending, "Okay, what do I do?" or the alternative "I'm going to do it the way I want because I read it in a book" (which I have also seen). Either of those attitudes gets you punted back to retractor duty.

You can tell residents who are "students of the OR". We have some juniors who step in and ask for the right instruments and are careful and well-prepared and know how attending does XYZ so we don't need to rehash everything and the operation flows smoothly as a result. And those people get more and more autonomy. And they know this stuff because they're modeling behaviors that they've observed. And we have some (type #2) who step in and expect the chief to tell them which instruments to use and argue when they struggle and then get cases taken away from them because they're unprepared. Not because they're stupid or technically incompetent, but because they expect to show up and be given cases and be handheld through them. The few that I have in my mind who are type #2 are those that invariably are nowhere to be found when they could be second assist.

 

[mimelim]

Just did a guillotine amputation of a septic patient. Yay for vascular Fridays and 4pm consults for septic patients secondary to dead feet. Other than tying off the vessels my MS3 did the entire case, all 30 minutes of it at least... Scalpel, bovie, power saw and then while I dressed it she did the central line with anesthesia. I'm sorry that your surgery rotations suck. Yes, this MS3 had to stay until 7pm on a Friday. But, ****, I think that she thought it was worth it.

As I finish up away rotations and get closer to matching, I wondered why junior residents would ever always volunteer to double scrub. On one of my aways a PGY2 was always there literally not doing anything until closing. I HATE the student experience now where if there is more than 1 physician scrubbed I'm basically relegated to suctioning or whatever else I can get my hands on to feign interest.

I suppose I can see what the other person just said.. learning how to close fascia is a crucial skill, so I can understand going. Personally though, (and I do love being in the OR) I would rather be studying or handling floor work than twiddling my thumbs watching a case "for the experience." There are other ways to learn and become a better physician/surgeon than to stand around. I've been in 8-10 hour cases where the time flies by, because I'm actively involved. I've been in 3 hour cases, not doing anything, that make me want to shoot myself, even if the case itself is something interesting.

The first question virtually any staff surgeon asks before starting a case with a new resident or someone they haven't worked with a lot is, "Have you done this before?" If the answer is no, the next question is, "Have you seen it done before?" There is a reason for this. During my first carotid endarterectomy, I did the entire dissection, patch and closure. I'm not doing that without having double scrubbed at least a handful of them. It isn't about "learning to close fascia". It is about knowing the steps of the operation and what each step entails. It is about knowing the critical parts of each step and how you can harm the patient at each of them so you can avoid the pitfalls. It is about picking up the tricks that make your life easier. Good surgery is about having a plan and half a dozen backup plans for everything that could happen. You have to be able to do it smoothly and efficiently. You can't get that just by being a primary surgeon. There just simply isn't enough time. Every case that you show up to unprepared is a case that is going to get taken away from you. That is a wasted case.

Surgery is certainly about a lot more than just the OR. Many forget that. But, there is also a tremendous amount of time that needs to go into honing the physical skills. If you don't invest the time and energy up front, you will not get as much out of your later years. And it is obvious when you look at graduating residents who got the memo and who didn't.

 

[Hangry]

As I finish up away rotations and get closer to matching, I wondered why junior residents would ever always volunteer to double scrub. On one of my aways a PGY2 was always there literally not doing anything until closing. I HATE the student experience now where if there is more than 1 physician scrubbed I'm basically relegated to suctioning or whatever else I can get my hands on to feign interest.

As a fourth year student as well going into gen surg I too HATE the student role for everything outside the OR. Inside the OR though, I realized that usually when I would start to get bored it was because I got complacent and stopped pushing myself to understand the case. There is almost always something more to be gained, do I know the goal of the case right now, do I know the next steps, do I know what the instruments they are using are called, do I see the planes of tissue they are currently working with (you can usually find it even without loupes), even if I can't see in the belly I can watch their hands and see how they move. What small efficient moves do they make to manipulate the tissue, how are they providing exposure for the resident, heck even when they are just tying down a valve or something how are their hands moving to tie so much more quickly and efficiently than mine currently do. It's something that I didn't really start taking advantage of until fourth year. When I was a third year it was all, "oh this part is beyond my understanding" but now I try to take responsibility for knowing at least a rudimentary amount about every part of the case and it helps me engage with the case. Next year people are going to hand us the knife and say "go" and the more competent we are from the get go the more we will get to participate. It's also been the difference between getting bored as a third year during the choledochojejunostomy part of a whipple because I "couldn't see" and as a fourth year being able to stay engaged and learn something from almost every part of 4-5 hr open heart cases.

Obviously its not terribly efficient learning, but it's better than nothing and hopefully will make me one of VT's type #1 interns eventually. It's certainly more useful than I would have predicted it being at first. That said, I'm also not doing 9 surgery rotations this year or anything insane like that. It's not THAT worth it and I have a lot of other better rotations to be learning from 4th year, but I can understand now why double-scrubbing would be a good thing for a junior resident to do.

 

[Mr Roboto]

I hope my residents are even 30% as great as you. Seriously.

Just did a guillotine amputation of a septic patient. Yay for vascular Fridays and 4pm consults for septic patients secondary to dead feet. Other than tying off the vessels my MS3 did the entire case, all 30 minutes of it at least... Scalpel, bovie, power saw and then while I dressed it she did the central line with anesthesia. I'm sorry that your surgery rotations suck. Yes, this MS3 had to stay until 7pm on a Friday. But, ****, I think that she thought it was worth it.

The first question virtually any staff surgeon asks before starting a case with a new resident or someone they haven't worked with a lot is, "Have you done this before?" If the answer is no, the next question is, "Have you seen it done before?" There is a reason for this. During my first carotid endarterectomy, I did the entire dissection, patch and closure. I'm not doing that without having double scrubbed at least a handful of them. It isn't about "learning to close fascia". It is about knowing the steps of the operation and what each step entails. It is about knowing the critical parts of each step and how you can harm the patient at each of them so you can avoid the pitfalls. It is about picking up the tricks that make your life easier. Good surgery is about having a plan and half a dozen backup plans for everything that could happen. You have to be able to do it smoothly and efficiently. You can't get that just by being a primary surgeon. There just simply isn't enough time. Every case that you show up to unprepared is a case that is going to get taken away from you. That is a wasted case.

Surgery is certainly about a lot more than just the OR. Many forget that. But, there is also a tremendous amount of time that needs to go into honing the physical skills. If you don't invest the time and energy up front, you will not get as much out of your later years. And it is obvious when you look at graduating residents who got the memo and who didn't.

 

[evilbooyaa]

Just did a guillotine amputation of a septic patient. Yay for vascular Fridays and 4pm consults for septic patients secondary to dead feet. Other than tying off the vessels my MS3 did the entire case, all 30 minutes of it at least... Scalpel, bovie, power saw and then while I dressed it she did the central line with anesthesia. I'm sorry that your surgery rotations suck. Yes, this MS3 had to stay until 7pm on a Friday. But, ****, I think that she thought it was worth it.



The first question virtually any staff surgeon asks before starting a case with a new resident or someone they haven't worked with a lot is, "Have you done this before?" If the answer is no, the next question is, "Have you seen it done before?" There is a reason for this. During my first carotid endarterectomy, I did the entire dissection, patch and closure. I'm not doing that without having double scrubbed at least a handful of them. It isn't about "learning to close fascia". It is about knowing the steps of the operation and what each step entails. It is about knowing the critical parts of each step and how you can harm the patient at each of them so you can avoid the pitfalls. It is about picking up the tricks that make your life easier. Good surgery is about having a plan and half a dozen backup plans for everything that could happen. You have to be able to do it smoothly and efficiently. You can't get that just by being a primary surgeon. There just simply isn't enough time. Every case that you show up to unprepared is a case that is going to get taken away from you. That is a wasted case.

Surgery is certainly about a lot more than just the OR. Many forget that. But, there is also a tremendous amount of time that needs to go into honing the physical skills. If you don't invest the time and energy up front, you will not get as much out of your later years. And it is obvious when you look at graduating residents who got the memo and who didn't.

Mimelim, I know I said this as a med student (who wanted to be at whatever hospital you're at) and I echo it now even as a resident very far removed from surgery - Keep doing what you are you doing with engaging your medical students. I wish you were the norm across the board, for all medical students with an interest in surgery. I know that it's hard when you inevitably run into those who have no desire to do anything during their surgery rotation and will show up unprepared, but keep encouraging those who do come prepared, in hopes that this attitude can somewhat propagate.

Also:

 

[Neopolymath]

Mimelim, I know I said this as a med student (who wanted to be at whatever hospital you're at) and I echo it now even as a resident very far removed from surgery - Keep doing what you are you doing with engaging your medical students. I wish you were the norm across the board, for all medical students with an interest in surgery. I know that it's hard when you inevitably run into those who have no desire to do anything during their surgery rotation and will show up unprepared, but keep encouraging those who do come prepared, in hopes that this attitude can somewhat propagate.

Also:

Well said. He seems like he would be the best. It's a shame most people in healthcare, and medicine in particular, suck...

 

[ortnakas]

Mimelim, I know I said this as a med student (who wanted to be at whatever hospital you're at) and I echo it now even as a resident very far removed from surgery - Keep doing what you are you doing with engaging your medical students. I wish you were the norm across the board, for all medical students with an interest in surgery. I know that it's hard when you inevitably run into those who have no desire to do anything during their surgery rotation and will show up unprepared, but keep encouraging those who do come prepared, in hopes that this attitude can somewhat propagate.

Agreed. Even as a not-future-surgeon, I can recognize that this is an amazing opportunity and your students are really fortunate to have you. Most of us are happy when we get to suction, drive a laparoscope, and help close. Keep doing what you're doing.

 

[Stagg737]

Just did a guillotine amputation of a septic patient. Yay for vascular Fridays and 4pm consults for septic patients secondary to dead feet. Other than tying off the vessels my MS3 did the entire case, all 30 minutes of it at least... Scalpel, bovie, power saw and then while I dressed it she did the central line with anesthesia. I'm sorry that your surgery rotations suck. Yes, this MS3 had to stay until 7pm on a Friday. But, ****, I think that she thought it was worth it.

Worth it? I would have come in at 7pm and stood on my head until 2 am if I got the chance to do that. That sounds way more than worth it, that would make my entire rotation and then some...