so I received an interview invite...BUT

[Femtochemistry]

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hey guys;

They want me to attend a surgical grand round; anybody have any experience about what this is all about?


cheers

 

[masterofmonkeys]

it's not a but. It's just like any other interview where they want to show the students the quality of their didactics. They're trying to impress you, not test you. Granted, they'll probably have stacked the deck wrt grand rounds speakers during interview season, but still...

Students are often invited to attend sessions, whether grand rounds or more intimate affairs.

 

[Winged Scapula]

Grand Rounds is a lecture, usually held in a lecture hall, generally once a month.

There is no pimping of students generally and as noted above, its a way for the program to show off. You are expected to attend and pretend to be interested in the topic.

 

[DarthNeurology]

Grand Rounds is a lecture, usually held in a lecture hall, generally once a month.

There is no pimping of students generally and as noted above, its a way for the program to show off. You are expected to attend and pretend to be interested in the topic.

When I did my surgery rotation we had Grand Rounds every week and they usually brought in a big-shot surgeon. The PD would introduce the speaker (usually with a personal story as the PDs seem to know a lot of big names), and it was usually impressive as some would talk about what procedure they pioneered and had been adopted around the world (literally eye popping!).

Even for medicine and peds every place I have seen does Grand Rounds at least weekly, although the topic and format may differ. I would think that not to many places only do monthly Grand Rounds?? Maybe that is just at dinky community programs??

 

[Winged Scapula]

When I did my surgery rotation we had Grand Rounds every week and they usually brought in a big-shot surgeon. The PD would introduce the speaker (usually with a personal story as the PDs seem to know a lot of big names), and it was usually impressive as some would talk about what procedure they pioneered and had been adopted around the world (literally eye popping!).

Even for medicine and peds every place I have seen does Grand Rounds at least weekly, although the topic and format may differ. I would think that not to many places only do monthly Grand Rounds?? Maybe that is just at dinky community programs??

I wouldn't know...I've never been at a dinky community program or a large community program for that matter.

Perhaps it differs at your hospital but our "Grand Rounds" were once a month which had the invited speaker, but there was a weekly lecture we had to attend as well. Perhaps it was just semantics; we considered Grand Rounds as when an invited lecturer came..weekly lectures with home faculty was not so "grand". 😀

This was true at my large academic residency and my different, but still large academic fellowship program. There was always a Grand Rounds every week, but some weeks it was Urology, sometimes Ob-Gyn, Peds, IM, sometimes PRS, etc.

Neither program, nor my current ones had weekly General Surgery Grand Rounds with invited speakers (who are expensive for programs - to fly someone out, wine and dine them and put them up in a fancy hotel once a week). Then again, those programs were much more about slavery than education.

Suffice it to say that it varies widely.

 

[DarthNeurology]

Perhaps it differs at your hospital but our "Grand Rounds" were once a month which had the invited speaker, but there was a weekly lecture we had to attend as well. Perhaps it was just semantics; we considered Grand Rounds as when an invited lecturer came..weekly lectures with home faculty was not so "grand". 😀

This was true at my large academic residency and my different, but still large academic fellowship program. There was always a Grand Rounds every week, but some weeks it was Urology, sometimes Ob-Gyn, Peds, IM, sometimes PRS, etc.

Neither program, nor my current ones had weekly General Surgery Grand Rounds with invited speakers (who are expensive for programs - to fly someone out, wine and dine them and put them up in a fancy hotel once a week). Then again, those programs were much more about slavery than education.

Suffice it to say that it varies widely.

Actually, where I did my surgery rotation we had a guest speaker every week come in, i.e. the program director or faculty didn't lecture ever for Grand Rounds and we had other weekly meetings to. The regular surgery faculty lectured us probably three hours a week outside of grand rounds and morning report. Grand Rounds was always Guest Star Day for us.

Some of the guest speaker were from other hospitals in town, but overall it must have cost some to do this. It was pretty impressive as I felt I learned a lot as a student. I am very surprised that there are academic surgery programs that do less.

As a student in one week doing surgery I would go to approximately 8 hours of surgery lectures, on most days of the week there were surgery lectures and Grand Rounds was a religious experience for everyone in surgery and the whole production went on for maybe 1.5 hours with questions. PLUS we had teaching rounds with surgery attendings on the floors learning floor management of surgery patients.

Granted this wasn't a top tier surgery program, but there was always a Peds Grand Rounds weekly and a Medicine Grand Rounds weekly which those of us in surgery usually didn't have time to go to . . .

I don't know what they do in Phoenix at your program Winged, but for a city of that size there must be a lot of academic surgeons who could give guest lectures and then maybe 1/4 to 1/2 the time you would have to fly in someone from somewhere else. The PD where I was at spent a lot of time scheduling to get in guest faculty each week and everybody discussed what they said all week, so he made it sound like an important part of residency training. . . although I am not a surgeon, having guest surgeons teach residents seemed to open their eyes to different fellowships and/or different ways of practicing surgery, or research they might want to do.

 

[Winged Scapula]

A
I don't know what they do in Phoenix at your program Winged, but for a city of that size there must be a lot of academic surgeons who could give guest lectures and then maybe 1/4 to 1/2 the time you would have to fly in someone from somewhere else.

I did not train in Phoenix, so the programs I am speaking of were in PA and NJ.

And yes, you may be suprised that academic programs do less, but since ACGME only requires 5 hours of lectures per week (which will include M&M, Interesting Case Conference, etc.), many will not do more. ACGME also does not require that those 5 hours includes lectures from faculty, so our resident education was often some last minute thrown together PP presentation given by a junior resident, not an attending. There are a lot of places that call themselves academic programs, but very little education goes on. I know many residents at other places who experienced the same lack of teaching, although medical students tended to get more than residents. Call me bitter.

What you experienced may be common at well funded, big name places, and you should consider yourself lucky to have experienced it because it is certainly not universal. "Morning Report" is not a common surgery practice and getting 3 hour lectures outside of the required ones is pretty special. The only bedside teaching/attending rounds we had were on SICU or occasionally on Trauma (although the entire team was never present, so it was hit or miss as to whether rounds happened when you were out of the OR or the Trauma Bay).

Phoenix is a very private practice town; Mayo is the only true big academic program here, although there are some smaller residency programs here with university affiliations or pure community programs. I was not speaking of programs here in my comments above about the monthly Grand Rounds. Mayo has weekly Surgery GR with visiting professors.

 

[DarthNeurology]

And yes, you may be suprised that academic programs do less, but since ACGME only requires 5 hours of lectures per week (which will include M&M, Interesting Case Conference, etc.), many will not do more.

Mayo is the only true big academic program here, although there are some smaller residency programs here with university affiliations or pure community programs.

I guess I didn't realize how lucky I was at the time, didn't realize that M&M was included, although that is important too. My surgical residents got less teaching because they were in cases a lot, but still everyone had to show up for Ground Rounds, or else . . . Morning report was more sign-out than a medicine morning report and I didn't include it in the 8 hours I got, actually 9 to 10 if you count M and M and tumor board.

Still, no way the hospital I was at was anywhere near being a well-funded surgery department, but they put a lot of effort into resident education. Maybe drug companies sponsored some of the speakers, but I don't remember any food, and most speakers were chairpersons at other surgery departments or editors of such and such journal. And this place was barely an academic hospital. . . but at least had all the requisite financial problems that went with being an academic center. But they wanted their residents to be well trained and to have good preparation for the ABSITE and they focused on this.

Even if every other speaker was from out of town, maybe they would spend 1-2 Grand on a speaker or maybe 30-40 thousand a year, . . . I don't know about the economics of surgery programs but this doesn't look too insurmountable (actually sort of looks like chump change to me in terms of a surgery department). The place was woefully understaffed, so maybe that is how they saved money.

Junior residents got a lot of "education" from the chief residents, although they had such glee with it I don't know if you could call it education.

While Mayo is currently the only big time academic center in Phoenix, . . . there will be construction of a major academic medical center (hospital) probably starting at the end of this decade with physical construction at the beginning of the next decade, . . . at least if things go the way they are going now. And it will eventually be bigger than Mayo.

 

[Femtochemistry]

thanks for answering my concerns fellas!

 

[dragonfly99]

femtochemistry
don't stress out about this
as pointed out above, the surgical Grand Rounds is very likely to be a lecture (with either an invited guest speaker or someone from the local surgical faculty). You'll go with the other interviewees and sit there. The program will be trying to impress you with their teaching. It's unlikely they will ask YOU any questions. Just sit in the lecture and act interested. Winged Scapula says they don't ask the house staff questions...I think it probably depends on the speaker and the program. As a student, I remember some of the sub-I's, interns and residents being "pimped" during surgical grand rounds and M + M conferences...though compared with what went on during rounds daily, I don't think the questioning was any worse. LOL. Glad I was never a surgical resident 🙂

 

[Winged Scapula]

femtochemistry
don't stress out about this
as pointed out above, the surgical Grand Rounds is very likely to be a lecture (with either an invited guest speaker or someone from the local surgical faculty). You'll go with the other interviewees and sit there. The program will be trying to impress you with their teaching. It's unlikely they will ask YOU any questions. Just sit in the lecture and act interested. Winged Scapula says they don't ask the house staff questions...I think it probably depends on the speaker and the program. As a student, I remember some of the sub-I's, interns and residents being "pimped" during surgical grand rounds and M + M conferences...though compared with what went on during rounds daily, I don't think the questioning was any worse. LOL. Glad I was never a surgical resident 🙂

I actually said there was no pimping of STUDENTS, so the OP going there for an interview would never be pimped. Its a sure way to turn off an interviewee is to embarass him.

House staff are very fair game!

 

[Winged Scapula]

I guess I didn't realize how lucky I was at the time, didn't realize that M&M was included, although that is important too. My surgical residents got less teaching because they were in cases a lot, but still everyone had to show up for Ground Rounds, or else . . . Morning report was more sign-out than a medicine morning report and I didn't include it in the 8 hours I got, actually 9 to 10 if you count M and M and tumor board.

Again, your "morning report" is not usual. Sign out in most hospitals occurs between the on call intern and the one coming in the am - its not a teaching session. But yes, weekly M&M is included in the required 5 hours of teaching. We only attended tumor board when it was held on certain services.

Still, no way the hospital I was at was anywhere near being a well-funded surgery department, but they put a lot of effort into resident education. Maybe drug companies sponsored some of the speakers, but I don't remember any food, and most speakers were chairpersons at other surgery departments or editors of such and such journal. And this place was barely an academic hospital. . . but at least had all the requisite financial problems that went with being an academic center. But they wanted their residents to be well trained and to have good preparation for the ABSITE and they focused on this.

Even if every other speaker was from out of town, maybe they would spend 1-2 Grand on a speaker or maybe 30-40 thousand a year, . . . I don't know about the economics of surgery programs but this doesn't look too insurmountable (actually sort of looks like chump change to me in terms of a surgery department). The place was woefully understaffed, so maybe that is how they saved money.

Perhaps. And I certainly cannot speak to my department's budget, but if they only give residents $300 for books and $50 for food, they would have been unlikely to spend $30-$40K/year for speakers. They spent some, but it was nowhere near weekly.

I'm still not sure why you are suprised that a lack of education exists out there; its not just surgery but many departments. People talk about it all over SDN.

While Mayo is currently the only big time academic center in Phoenix, . . . there will be construction of a major academic medical center (hospital) probably starting at the end of this decade with physical construction at the beginning of the next decade, . . . at least if things go the way they are going now. And it will eventually be bigger than Mayo.

Thank you. I am aware of the plans to build a satellite of UofA here as well as a Cancer Center of America. However, it will unlikely to be bigger than Mayo in name but will probably eventually have more patients as Mayo takes very few insurance plans currently.

 

[dragonfly99]

Actually Winged Scapula, they DID pimp students during surgical grand rounds at my medical school. But usually it was not us third year medical students, just more the 4th year subI's.

But I agree with Winged about the teaching conferences in general...the other poster is describing a LOT of didactic hours. He/she is lucky if he/she got that many. Actually we had a lot of teaching conferences at my med school's hospital, but how many the house staff had time to attend is another story 🙂

 

[Winged Scapula]

Actually Winged Scapula, they DID pimp students during surgical grand rounds at my medical school. But usually it was not us third year medical students, just more the 4th year subI's.

Again, my point was that the OP, as an interviewing student, would not be pimped. House officers and students on surgery rotations could and will be pimped. I'm sorry if I wasn't clear before.

But I agree with Winged about the teaching conferences in general...the other poster is describing a LOT of didactic hours. He/she is lucky if he/she got that many. Actually we had a lot of teaching conferences at my med school's hospital, but how many the house staff had time to attend is another story 🙂

Unfortunately for residents...it is true that as a student it appears that there is much more education going on than the residents are able to attend. We HAD Tumor Boards, lectures, etc. but with residents in the OR, Trauma Bay, rounding elsewhere, we were often unable to attend.

 

[DarthNeurology]

And I certainly cannot speak to my department's budget, but if they only give residents $300 for books and $50 for food, they would have been unlikely to spend $30-$40K/year for speakers. They spent some, but it was nowhere near weekly.

I'm still not sure why you are suprised that a lack of education exists out there; its not just surgery but many departments. People talk about it all over SDN.

I guess I am surprised because the cost of bringing in speakers is relatively low. Most University surgery programs have an annual budget of 25 Million dollars, that goes to everything from salaries to I guess new equipment for the ORs to quite often very high perhaps too high salaries for the chairperson.

So spending around $40,000 would be about 0.16% of the surgery departments budget. This program also didn't give much, if any, free food for the residents. So, I don't think you can extrapolate in the end how financially sounds your residency program is based on how much money the residents get for food in the cafeteria. In the end it is where you want to put your priorities.

In terms of OR conflicts, Grand Rounds Day usually had a couple of other lectures and residents were usually excused and asked by the surgical attendings to go to Grand Rounds over the OR. I saw a surgical resident get yelled at for loittering around the OR holding area in scrubs when the lectures were going to start in 5 minutes. I did know that the surgery PD had "talked" with the surgery attendings about getting the residents out to Grand Rounds and the other lectures that happened that day and they were very OK with it. Maybe ACGME states somewhere that surgery residents have to be available to get their 5 hours a week of lectures??

 

[dragonfly99]

Darth,
the ACGME says a lot of things...and requires a lot of things. Those things don't always happen anyhow though.
Even as a medicine resident (especially intern) there were sometimes "required" conferences that there was no way in hell I had time to attend, since there were patient care duties that had to be attended to. I'm sure it happens to surgery residents more often...though I don't doubt there are programs out there where the surgery attendings would toe the line about sending their residents to required conferences either. Winged Scapula is just pointing out that it ain't necessarily so, even at academic programs.

 

[DarthNeurology]

Darth,
the ACGME says a lot of things...and requires a lot of things. Those things don't always happen anyhow though.
Even as a medicine resident (especially intern) there were sometimes "required" conferences that there was no way in hell I had time to attend, since there were patient care duties that had to be attended to. I'm sure it happens to surgery residents more often...though I don't doubt there are programs out there where the surgery attendings would toe the line about sending their residents to required conferences either. Winged Scapula is just pointing out that it ain't necessarily so, even at academic programs.

Yes, I am aware that programs sometimes come up short when it comes to following the ACGME rules. The program where I did my surgery clerkship certainly had its share of complaints, often vocalized by the residents about the malignant nature of the place. . .

HOWEVER, the PD was able to set aside one morning roughly for grand rounds and other lectures and all the surgical attendings knew that all the residents from the chiefs to the juniors were required to attend lectures so it wasn't a problem. Believe me, an attending with three scrub techs can do a blockbuster job on a routine appy or what have you.

While there is always the possibility that something will come up, I believe that getting residents in to do lectures one morning is just a logistical problem with a simple solution, i.e. don't schedule too many surgeries during this time or do clinic or paperwork during this time. Perhaps even half of the attending surgeons took this morning off as well to show up in suits for the Grand Rounds, it was something that has gone on for years and was therefore are already seamlessly integrated into the schedule.

The alternative is that lectures are hit and miss and no one is required to go to anything. Over a 5 year surgical residency having residents go to basically every single grand rounds adds up in education value.

So, I would conclude that the surgery residency programs where residents are required to say scrub in on their 500th appy while someone who invented laproscopic procedure x is lecturing is just a plain and simple sloppy way to run a program. Technical skills can be learned easily in the OR but listening to how a world expert manages a certain type of patient is priceless.

So maybe if someone is interviewing for surgery residency positions they would be wise to ask the residents how easy it is to go to conference and do board review or even what if any conferences are offered.

 

[earmuff]

This is probably one of the most useless threads I have ever had the misfortune to read.

The way I see it, you people owe me for a part of my life I will never get back.

I accept payment in the form of flaming.

 

[Winged Scapula]

This is probably one of the most useless threads I have ever had the misfortune to read.

The way I see it, you people owe me for a part of my life I will never get back.

I accept payment in the form of flaming.

Pretty presumptuous for someone who has only been a member here for 2 months.

Let Darth and I continue our discussion without your asinine involvement.

😉

Flaming free of charge!

 

[Winged Scapula]

Yes, I am aware that programs sometimes come up short when it comes to following the ACGME rules. The program where I did my surgery clerkship certainly had its share of complaints, often vocalized by the residents about the malignant nature of the place. . .

HOWEVER, the PD was able to set aside one morning roughly for grand rounds and other lectures and all the surgical attendings knew that all the residents from the chiefs to the juniors were required to attend lectures so it wasn't a problem. Believe me, an attending with three scrub techs can do a blockbuster job on a routine appy or what have you.

Clearly. This has oft been one of my snide comments about how apparently some surgeons can actually operate without a resident there. Shocking, as that apparently was not the case at my residency program. Funny how I am somehow able to muddle through without a resident.🙄

While there is always the possibility that something will come up, I believe that getting residents in to do lectures one morning is just a logistical problem with a simple solution, i.e. don't schedule too many surgeries during this time or do clinic or paperwork during this time. Perhaps even half of the attending surgeons took this morning off as well to show up in suits for the Grand Rounds, it was something that has gone on for years and was therefore are already seamlessly integrated into the schedule.

The alternative is that lectures are hit and miss and no one is required to go to anything. Over a 5 year surgical residency having residents go to basically every single grand rounds adds up in education value.

You're preaching to the choir. We all agree that these things are important, but many programs and faculty are unable to figure out how to put everything together. We had ONE (yes, ONE) faculty member who would shoo us out of the OR when it was time for our "mandatory" lectures. The others would feign ignorance about the schedule, demand that you stay, throw a hissy fit, or intimidate you into being fearful of saying anything. It was especially bad for the junior residents who felt they couldn't speak up.

So, I would conclude that the surgery residency programs where residents are required to say scrub in on their 500th appy while someone who invented laproscopic procedure x is lecturing is just a plain and simple sloppy way to run a program. Technical skills can be learned easily in the OR but listening to how a world expert manages a certain type of patient is priceless.

I actually disagree with you here. Practice makes perfect in surgical training. While many lectures are priceless and worth their weight in gold, you may need that 500th appy (which is a highly unrealistic number, BTW) to reach the zenith of the learning curve. There is a reason why its a lengthy residency and you don't always get the opportunity to do certain cases; they present themselves when they present, mandatory lecture or not. Most surgical residents will refuse to attend a mandatory lecture if there is a great case going on; regardless of what ACGME or anyone else says.

So maybe if someone is interviewing for surgery residency positions they would be wise to ask the residents how easy it is to go to conference and do board review or even what if any conferences are offered.

Perhaps. But since residents are well known to lie about these things, it would be hard to ascertain what the real answer is. Better to ask the medical students at that program what the skinny is.

 

[DarthNeurology]

You're preaching to the choir. We all agree that these things are important, but many programs and faculty are unable to figure out how to put everything together. We had ONE (yes, ONE) faculty member who would shoo us out of the OR when it was time for our "mandatory" lectures. The others would feign ignorance about the schedule, demand that you stay, throw a hissy fit, or intimidate you into being fearful of saying anything. It was especially bad for the junior residents who felt they couldn't speak up.



I actually disagree with you here. Practice makes perfect in surgical training. While many lectures are priceless and worth their weight in gold, you may need that 500th appy (which is a highly unrealistic number, BTW) to reach the zenith of the learning curve. There is a reason why its a lengthy residency and you don't always get the opportunity to do certain cases; they present themselves when they present, mandatory lecture or not. Most surgical residents will refuse to attend a mandatory lecture if there is a great case going on; regardless of what ACGME or anyone else says.

Well, practice doesn't always make perfect as I got to observe a surgeon who generally described as incompetent to everyone behind his back. Even the PD said that you can learn a lot from him because you learn more from poor surgeons by watching them make mistakes than from someone who doesn't. So, I think if you don't have the skills and personality to be a great surgeon you won't get there with just practice.

But I have heard some surgical attendings say that they can teach anyone excellent surgical skills in the OR, but that it takes something more to be a great surgeon. I.e. more than just a technician.

Personally I have seen residents bumble around the in OR and have trouble doing simple things, may because they don't have any surgery related hobbies like car repair or doing something complicated with their hands. Maybe for such residents seeing hundreds of appys is what they need then. But mostly, I think surgical residents get reamed for not doing good post-op care or pre-op evaluation or managing the patient prior to surgery well. None of which has anything to do with what happens in the OR.

I think the "great cases" can teach you just as much as the routine cases as often the same management questions are asked, i.e. indication for the procedure, anatomy, etc . . . Usually when I hear resident's talk about a "great case" it is a complicated trauma surgery or a surgery where an unexpected complications happened and the colon perforated in the OR. And the residents are AWED that there was fecal matter everywhere and talked about it for hours. Every case can be a "great case" if you look at the specifics of the patients and read up on it.

I think usually a "great case" means a very exciting case which might not necessarily mean a great learning experience. At any rate there weren't any "great cases" going on in the OR during our Surgery Grand Rounds as they shut down the OR basically for everything except trauma.