Scary Walk Rounds?

[JayDoc06]

Louisville had our first interview today and we broke from the tradition of taking the applicants on our weekly ICU walk rounds. Apparently this had evoked very negative reviews from applicants in recent years. Is it really that bad to watch a group of residents present sick, complex patients to Dr Polk and company? Does the prospect of this activity really scare off prospective residents? Do people not realize the skills it takes to perform such a task and then not want to be able to do that? Are applicants wanting to be babied through training? Or is it just that this is not an appropriate activity for interview day?

It appears as though students are just scared of doing it one day and therefore would rather avoid our program all together.

Am I misreading this?

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[dpmd]

Well, I have to wonder what exactly goes on on these rounds. Are the residents berated and belittled as they fumble through a presentation with frequent interruptions by the attendings? Are people being singled out and pimped relentlessly on esoteric information? Are wrong answers met with physical violence? Do rounds take more than five hours?

I need more info before I can formulate an opinion.

 

[njbmd]

Louisville had our first interview today and we broke from the tradition of taking the applicants on our weekly ICU walk rounds. Apparently this had evoked very negative reviews from applicants in recent years. Is it really that bad to watch a group of residents present sick, complex patients to Dr Polk and company? Does the prospect of this activity really scare off prospective residents? Do people not realize the skills it takes to perform such a task and then not want to be able to do that? Are applicants wanting to be babied through training? Or is it just that this is not an appropriate activity for interview day?

It appears as though students are just scared of doing it one day and therefore would rather avoid our program all together.

Am I misreading this?

There are "scary" people and experiences in every residency program. My guess is that your program is no more scary than any others. In my experience, those attendings who demanded the most of residents generally received the best from those residents. Challenge is a good thing and not scary at all. Of course, I can totally say that some of those scary interrogations have served me well when a patient is trying to die under my care and I am glad that I was exposed to them. It's also good to have a few "scary" encounters before you get to oral boards too.

 

[Lance]

As an applicant, I think you're probably misreading. To be honest, I wouldn't want to go on walk rounds. I don't think how rounds are done is something that distinguishes programs from each other, but it certainly can take a long time. Most of us are using our precious days off to come to interviews and we don't want to feel like we're at work during an interview. I would much rather talk about the ins and outs of the program (no pun intended) than talk about patients. Also people are probably afraid of getting judged on rounds, which I would imagine doesn't happen too much, but there's enough pressure to perform on solo interviews, and imaginably all the applicants that you're interviewing are smart enough to do fine in the program, but certain students may try to steal the show on rounds, which could be an uncomfortable situation.

 

[tri]

yeah, i don't really understand why the negative reviews come about from this. I mean, if i was an applicant, nothing would turn me onto a program more than watching "hire em, fire em" polk bitch slap a junior resident, old school style! #1 baby!

 

[Winged Scapula]

Heh...

I remember very well the ICU rounds with HP. I was less than impressed with seeing the CHIEF residents visibly shaking when presenting a patient. It had nothing to do with not wanting to work hard but wanting to be in a place where you weren't terrified after 5-7 years.

But for most applicants, its probably more a matter of too much of a good thing...ok to stop by walk rounds, but the entire thing? Overkill. There's also probably an element of fear about possibly being pimped on the rounds. Interviewing is stressful enough without adding that fear on top.

Why did you stop doing it?

 

[logistic]

In my humble opinion, it is a bit unseemly for a group of 'suits' to walk through a ward with the sickest of patients.

 

[JayDoc06]

Interesting responses.

Just to clarify. Walk rounds are when, once a week, the second year intensivist and chief present the 8-10 most interesting patients in the SICU to the trauma attendings, chairman and "chairman emeritus" with rotating students and other residents also in attendence. As fas as I know, it is rather unique to our program. We used to have interviews on Monday and traditionally took applicants to this (as observers of course) as the first event during the interview day. I have heard a wide range of responses to this activity. Anything from "wow! I was impressed by the confidence and knowledge needed to do that" to "holy sh$t! I would rather be the interesting patient than present the interesting patient."

I can't speak for years ago but the previously mentioned HP has mellowed quit a bit and anymore provides more comic relief and interesting historical perspectives than anything else. Haven't seen many shaking chiefs recently.

I guess my question is does the prospect of this activity deter applicants and would most rather just learn the "cold hard facts" of the program and ask the residents about duty hours while on an interview?

 

[dienekes88]

Just a few guesses from an MS-1...

Students interviewing for medical school don't necessarily check out classes on their interview days and definitely don't visit the anatomy lab. It's just not productive. Visiting a class, a lot of the material will be boring/over their heads. In the case of anatomy lab, it shows a lack of compassion for those who have donated their bodies to medicine. In the same way, it might be inappropriate for these interviewees to go on walk rounds. They have little to contribute (they're not residents); they may not know what's going on; and they have nothing to do with the patient's care.

The interview day is stressful enough; being on your feet and walking around probably contributes to that stress. If you're tired and cranky from travel and then you have to walk around, I can imagine you might associate your negative feelings to the residency program instead of to your own exhaustion.

 

[droliver]

Walk rounds at UofL are a very formal didactic method that used to be very common on teaching wards. What makes it kind of unique at Louisville is just how much Dr. Polk does not suffer fools gladly and his somewhat legendary personality. You learn soooo much from those type of sessions.

I think some applicants were taken aback by just how candid these presentations are in that some of the staff didn't hold back just because medical students applying to the program were present. If you did something wrong or dumb you'd get lit up publicly. Looking back, I think the discipline of this kind of presentation serves you well. When I sit thru presentations by residents now, I just cringe at how incoherant and informal it is in most instances.

 

[ESU_MD]

Did your program really think this was special in some way?

.

They probably do. How many places have a guy like Hiram Polk floating around? I imagine that the residents who lead Dr Polk on rounds bring the A-game and it is a good experience they brag about (once it's over- of course)

Wouldn't you want to have the honor of presenting patients to a Dr Polk or Cameron someday?

I dont think the applicants should get pimped, but seeing these rounds for 20-30mins could be a good selling point for the program.

 

[dpmd]

Just to clarify. Walk rounds are when, once a week, the second year intensivist and chief present the 8-10 most interesting patients in the SICU to the trauma attendings, chairman and "chairman emeritus" with rotating students and other residents also in attendence. As fas as I know, it is rather unique to our program.

We did a similar thing at my med school. I though it was one of the most beneficial experiences I had as a student. The residents didn't seem overly nervous about it, but they definitely had to have their sh.t together to present (and no one in the group was immune to questions, the attendings would spread the love around starting with students and move their way up.). Unlike other parts of the department, the trauma guys were more into teaching than humiliation so I don't think it would be a turnoff for potential applicants (but they didn't have applicants join us)

I can understand why people wouldn't want to be thrust into something like that unprepared though.

 

[elr1983]

Louisville had our first interview today and we broke from the tradition of taking the applicants on our weekly ICU walk rounds. Apparently this had evoked very negative reviews from applicants in recent years. Is it really that bad to watch a group of residents present sick, complex patients to Dr Polk and company? Does the prospect of this activity really scare off prospective residents? Do people not realize the skills it takes to perform such a task and then not want to be able to do that? Are applicants wanting to be babied through training? Or is it just that this is not an appropriate activity for interview day?

It appears as though students are just scared of doing it one day and therefore would rather avoid our program all together.

Am I misreading this?

Personally, as an applicant, I wouldn't mind watching residents present and get questioned and taught. However, I think that in surgery (at my school, anyhow), if you're wrong, you're immediately berated, called stupid, yelled at, etc. Usually there are a few choice obscenities thrown in there, too, just for good measure. It was one thing that really shocked me about surgery/surgeons, and it really turned me off the entire specialty. So, if I were an applicant who came from a school where that wasn't the case (I'm told that there are surgery programs where this is not the norm, and that I attend a notoriously malignant program), I'd likely be pretty shocked and not want to rank the place. I think the first time you see a grown man literally throw a temper tantrum over an incorrect answer, it's pretty shocking, even if you get used to it with time.

And also, just because you don't want to be screamed at and berated doesn't mean you don't want to learn or work hard. But, as I said, I am not applying to surgery, mostly because of these sorts of personalities, so perhaps surgery applicants are less bothered by it. I know the few coming from my program won't care.

 

[Pilot Doc]

. I don't think how rounds are done is something that distinguishes programs from each other,

Clearly, you have not seen Hiram Polk lead an entire department through the ICU and serially pimp everyone from medical students up through his own attendings.

And yes, I think it probably scares a number of people off. I'd bet Dr. Polk thought that was for the best. Maybe the current chairman wants to set a new tone.

 

[ESU_MD]

I dont think any human being likes being publicly humiliated or yelled at, etc..

In surgical training, there has to be a fine line between being accountable and being humiliated. It cant all be handing out milk and cookies and pats on the back. If you forget to check something and the case gets screwed up, or the patient is harmed because of lack of attention or knowledge- its someones fault and that person must be accountable. doesnt mean public humiliation, but it does work.

Looking back at gen surg residency- you just dont have the same aspects of training from an attending you have got drunk with at happy hour than with someone you fear.

 

[Celiac Plexus]

To the OP: Perhaps medical students don't realize that Hiram Polk is a surgical legend. Lousiville may think that the unique, and for most a once in a lifetime opportunity, to see Dr. Polk in action is a gift to interviewees and a nice perk to the day. I certainly see it that way. But if medical students don't realize what they are seeing, and just view it as an odious part of the interview then I can see why it's not that effective of a sales tool. Hiram Polk is one of the last semi-active giants in surgery and if there was a textbook called "Polk" like there is for Sabiston, or Cameron, maybe more of today's students, and residents, would appreciate the value of a day of rounds with the man.

If I hand someone a 10 carat diamond and tell them it's theirs to keep, but that person doesn't know a diamond from a dingleberry, then that person is unlikely to be positively impressed. Just the opposite actually.

 

[SLUser11]

If I hand someone a 10 carat diamond and tell them it's theirs to keep, but that person doesn't know a diamond from a dingleberry, then that person is unlikely to be positively impressed. Just the opposite actually.

Best...line...ever.

I've never met Dr. Polk, but he sounds awesome from my audio digest recordings and my attending's description......that doesn't mean I wouldn't pee myself if he starting grilling me.

 

[Sarcophageal]

No matter the school or the attending, I would like to see an accurate portrayal of rounds, M&M, and resident-attending interaction. I think that is the reason for the interview. I would like to see the "scary walk rounds" or the sweet-n-lo covered presentations at M&M. I know some schools probably put on a show, but I'd hope my interview experience isn't from a script but the real deal. That way I can decide what i want.

 

[njbmd]

Personally, as an applicant, I wouldn't mind watching residents present and get questioned and taught. However, I think that in surgery (at my school, anyhow), if you're wrong, you're immediately berated, called stupid, yelled at, etc. Usually there are a few choice obscenities thrown in there, too, just for good measure. It was one thing that really shocked me about surgery/surgeons, and it really turned me off the entire specialty. So, if I were an applicant who came from a school where that wasn't the case (I'm told that there are surgery programs where this is not the norm, and that I attend a notoriously malignant program), I'd likely be pretty shocked and not want to rank the place. I think the first time you see a grown man literally throw a temper tantrum over an incorrect answer, it's pretty shocking, even if you get used to it with time.

And also, just because you don't want to be screamed at and berated doesn't mean you don't want to learn or work hard. But, as I said, I am not applying to surgery, mostly because of these sorts of personalities, so perhaps surgery applicants are less bothered by it. I know the few coming from my program won't care.

No matter the school or the attending, I would like to see an accurate portrayal of rounds, M&M, and resident-attending interaction. I think that is the reason for the interview. I would like to see the "scary walk rounds" or the sweet-n-lo covered presentations at M&M. I know some schools probably put on a show, but I'd hope my interview experience isn't from a script but the real deal. That way I can decide what i want.

Just about every good program has the "old school" legends. They are becoming fewer and far in between though. Back in the dark ages, I remember a tale from one of the chief residents at VCU about a CT surgeon who was infamous for his temper and antics in the OR. One day, he collapsed while operating and went "down" swearing while the fellow and the residents completed the case.

There are potentially "scary" things everywhere. If these tactics are used too often, they become fodder for lore rather than any kind of teaching technique. I have to say that I remember the lessons that were taught with pointed and accurate teaching rather than berating as well as the ones that came with a high level of discomfort. In the end, they can yell as much as they like as long as they don't tough you.

Seeing a good teaching session was integral to the choices that I made in terms of ranking. The best I saw was Mayo in Rochester, MN. There were plenty of poor ones where the attendings didn't teach at all. Needless to say, I didn't rank them.

 

[madtowngirl]

Maybe I saw ICU rounds on a day when Dr. Polk was more mellow, but I remember being bored more than anything else. I was impressed by the residents' composure in presenting to such a large group of people (which still terrifies me). What really showed me the true colors of that program was actually the M&M presentation we saw later that day. And for that comment earlier about getting to scrub with him, I've been told that he's more of a critical care presence than a surgeon, and doesn't spend much time in the OR.

 

[radslooking]

xx

 

[opr8n]

IMO, the point of surgical education is to expose you surgical ignorance so you can correct it. I have has myazz handed to me a few times in residency and those are the pateints and situationd i hav elearned the most from. You will never forget those things or ,miss them again. I think if people want to be babied, they should go into a different field

 

[MOHS_01]

As a former Louisville student I can say, beyond the shadow of a doubt, that Hiram Polk "the man" is every bit worthy of the legend. Intimidating, yes. Awe inspiring, yes -- to know what he has done, what he has seen, the level of excellence that he demanded was nothing short of inspirational. He scared me to death (and I knew that I was not going into GS), but I hung onto every last word. From "melanoma is the cancer that gives cancer a bad name" to "all bleeding stops" to "big dam* vein" to "perfect is the enemy of good" to "GD, David... if you cannot answer a simple question you will not finish this program" the man provided memories that will not soon be forgotten. If fear of intimidation trumps a thorough command of topics and excellence in execution, then you would be best served staying away from his program.... and so would the program. Dr. McMasters may not have the flare of Dr. Polk, but make no mistake about it -- he is very much the protege of "Hiram & fire 'em". I can promise you that there was a sense of sadness, of an era passing, when Dr. Polk handed off the reins.

 

[waffletamu]

hi guys, current U of L resident here. We moved interviews to fridays this year because more interviewees were requesting more time with residents than the social the night before and tours during the day.

So, we took our q friday lecture time for the students interviewing to talk to the residents as a whole group.

As for the Polk thing: I have presented walk rounds many times to Dr. Polk, and have many left to go. Only once have I felt anything less than supported by him, and that was b/c I didn't have my crap together. He makes you better in so many ways. I have also operated with him probably 15 times now, and there is no better teacher for a junior resident: no wasted movement, no wasted suture, excellent technique.

If anyone wants to know what the program is really like right now, please email and ask or post. I also have a guest room if people need on the interview trail!


Oh, and since I have your attention, pray for my Texas A&M Football team. We are going to need a miracle to beat Texas.