:( sub-i

[avgjoe]

I've been on my sub-i for a little more than a week now and am having a tough time. It's crazy not having enough time to properly take care of patients, to go into the OR, prepare for the OR, read and ask good questions, or any one of the above. Not to mention that there is no time to sleep. I feel less prepared than a third year.

Anyone feel like this and then have things turn around the next week? hoping against hope..

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[blue2000]

I actually thought my sub-I was a much more difficult experience then the third year clerkship for a couple of reasons...

1) I had much higher expectations for myself. I felt as though I have a knowledge level closer to the residents than to the third years, and I expected myself to know every question the attendings would ask me. On a related issue, I was getting letters, so every minor imperfection I used as proof I wouldn't get the letter I wanted from the attending.

2) It was long hours. I was in before the intern and out with the chief at night; sometimes I felt as though my hours were longer than anyone else's on the team. And, due to issue #1, I couldn't ask for a break.

3) I was lonely. I wasn't a third year, I wasn't a resident. I was this weird middle ground, no one was really looking out for me, and the expectations weren't as clear as they had been third year.

It's a hard spot to be in. Despite the difficulty, I still adored the OR, had a ton of fun with my team, loved my patients, and felt more engaged than I did the rest of fourth year, which is how I got through it. If you're not feeling the ups as well as the downs, think seriously about surgery (if you're contemplating it). It's not worth it if you can't find the passion in the midst of the fatigue, stress, fumbling, and worry.

 

[mddo2b]

I've been on my sub-i for a little more than a week now and am having a tough time. It's crazy not having enough time to properly take care of patients, to go into the OR, prepare for the OR, read and ask good questions, or any one of the above. Not to mention that there is no time to sleep. I feel less prepared than a third year.

Anyone feel like this and then have things turn around the next week? hoping against hope..

its supposse to be hard...so you get a taste of internship and make an educated decision of the life of a surgical resident...trust me it will get easier, just dont give up

 

[Celiac Plexus]

my 4th year surgical rotations' typical days were significantly longer than my intern/resident typical days. as a student i easily worked 120 hour weeks.

it is a weird place to be in for the reasons you stated. but just try to be an intern. do all of the things the intern does, and help out as much as possible. it's really important to "fit" into the team well, and though i can't tell you exactly how to do this, you can't go wrong by being the first one in, and the last one out, doing as many "little things" as possible. write complete notes, even if you think they're too long. write extensive assessments/plans to show your thought process... contact with attendings may be brief/intermittent, but they usually read the chart closely and will notice your conscientious notes/post-ops/op-notes etc... also, help out the other students as much as possible. these things get noticed.

use a pimp book like surgical recall to bone up on cases. you won't know every answer, but know a few at least. make sure you know the anatomy of the operations you scrub on. it kinda sucks but the attendings' impressions of you can be heavily affected by brief pimpesque interactions so be prepared. most importantly though, feedback from the service chief and residents will affect your evaluation a lot too. if you get on well with your team, you will get a good eval.

most importantly, don't sweat your mistakes. they happen to everyone. don't get down on yourself if you don't know a pimp question. just say you don't know, but that you will look it up. a true pimp session always ends with a befuddled student/resident anyway... the questions keep coming until you miss one!

best of luck!

 

[Espion]

I'm a little concerned aboutmy 4th year away rotations in surgery. I do despise using the term 'audition rotation', but how do you tread the fine-line of being proactive, involved, yadda-etc. while not pissing of the students that are trying to make it through their 3rd/4th year rotation?

Honestly, I can see how easy it would be for the natives to have a low tolerance for visiting students invading their territory. Where's the balance between making sure you are known and remembered by the attendings/residents and not screwing your fellow brethren over in a bad houseguest kind of way?

 

[Winged Scapula]

I'm a little concerned aboutmy 4th year away rotations in surgery. I do despise using the term 'audition rotation', but how do you tread the fine-line of being proactive, involved, yadda-etc. while not pissing of the students that are trying to make it through their 3rd/4th year rotation?

Honestly, I can see how easy it would be for the natives to have a low tolerance for visiting students invading their territory. Where's the balance between making sure you are known and remembered by the attendings/residents and not screwing your fellow brethren over in a bad houseguest kind of way?

There will be some "home" students who resent visiting clerks, especially if the rotation is a prized one or in a competitive field in which they also hope to match (I ran into one of these during a 4th year PRS rotation). There will be little you can do to appease them but if you do the following, the attendings and residents are sure to see through their own students and see you for the wonderful visitor you are:

- like all houseguests, offer to help out. This means being available, interested and always around when needed. Evenmoreso, as a 4th year student you should be able to anticipate your host's needs and be able to satisfy them (ie, have dressing supplies on rounds, write pre and post op notes on your patients, attempt to write orders, etc.)

- like all houseguests, mind your own business. When trying to shine, most students screw up by also rounding on their fellow student's patients. Thus, when your fellow student doesn't know the answer to something about his patient (but you do because you've been following the same patient [without being asked to...just because you wanted to look good]), don't pipe up with the answer. You'll just look like a stooge or even worse, aggressive. Either whisper the answer to your colleague or surreptitiously write it down so they (but not the resident or attending) can see it. And then stop rounding on their patients.

- like all houseguests, clean up after yourself (ie, if doing a procedure, don't leave a mess; if following a patient and you have to leave, make sure if there's a problem someone knows about it)

- like all houseguests, divide the chores equitably - don't steal all the "good" cases nor should you be expected to be doing the majority of the scut or lame cases

- don't kiss up, but if you can do something that makes all the students look good (ie, bringing doughnuts to a conference - but say that everyone pitched in,instead of taking credit alone), do it
- be polite, friendly and hard working without shafting your fellow students and you'll do fine.

 

[Leukocyte]

- like all houseguests, mind your own business. When trying to shine, most students screw up by also rounding on their fellow student's patients.

I HATE this type of behavior! I really cannot stand this.

Some students did this when I was a 3rd year. Some would round on my patients, and even scrub in on my cases.

If and when I become a chief/attending I will EAT THESE TYPE OF STUDENTS ALIVE!!!!!!!!

 

[Espion]

There will be some "home" students who resent visiting clerks, especially if the rotation is a prized one or in a competitive field in which they also hope to match (I ran into one of these during a 4th year PRS rotation). There will be little you can do to appease them but if you do the following, the attendings and residents are sure to see through their own students and see you for the wonderful visitor you are:

- like all houseguests, offer to help out.

- like all houseguests, mind your own business.

- like all houseguests, clean up after yourself

- like all houseguests, divide the chores equitably

- don't kiss up, but if you can do something that makes all the students look good (ie, bringing doughnuts to a conference - but say that everyone pitched in,instead of taking credit alone), do it

- be polite, friendly and hard working without shafting your fellow students and you'll do fine.

Thanks for the advice! Hopefully I won't have too many problems. Another one of my issues is the fact that the rotation itself is almost completely foreign to me (its a pediatric surgery elective...I've seen exactly two pediatric cases here, and that was after I sought them out).

I never thought of someone rounding on your patients. I would have such a MAJOR bout of conscience prairie doggin' me, I could never do something like that. That's just bad juju all around.

 

[Winged Scapula]

Thanks for the advice! Hopefully I won't have too many problems. Another one of my issues is the fact that the rotation itself is almost completely foreign to me (its a pediatric surgery elective...I've seen exactly two pediatric cases here, and that was after I sought them out).

I never thought of someone rounding on your patients. I would have such a MAJOR bout of conscience prairie doggin' me, I could never do something like that. That's just bad juju all around.

Unfortunately, outside of my own experience with another student doing it to me (when I was doing a visiting elective - fortunately, both the Chief resident and attending recognized it and told me they knew what was going on. They saw the student for what he was; matter of fact, when I returned months later for an interview, they were still commenting about it. The student in question ended up matching into an Integrated PRS program but NOT at his own home program.), I understand its pretty common. I cannot imagine doing it either.

Don't worry about not having much experience with Peds Surg. Chances are none of the other students rotating will either.

 

[LovelyRita]

Some students did this when I was a 3rd year. Some would round on my patients, and even scrub in on my cases.

...glad I'm not the only one who's experienced this. I'm still reeling.

Anyway, I'll be starting my sub-i in a few weeks. I'm already ruminating about it (can you tell I'm on psych right now?)

I think the problem I might run into is the train-wreck patients that inevitably suck me in and I feel like the clock is ticking while I sort out their situation. (usually a new patient).

Kim or anyone else have advice on managing time/staying organized while doing a sub-i? What is most important in the eyes of senior residents/attendings when they are working with a 4th year doing a sub-i?

M.

 

[Winged Scapula]

There is nothing wrong with spending a lot of time with a patient as a student - its really your last chance to really do so; however, you've obviously got other things to do. Thus, learning the fine art of cutting the patient off or interrupting them comes in handy. Most of us are loathe to do it as we're trained by our parents that its rude to do so. It is. But its necessary sometimes when dealing with the patient who have a list a mile long of diagnoses (invariably including fibromyalgia), allergies (invariably including "Morphine makes me nauseated" and "Benadryl makes me sleepy" as allergies) and Meds (invariably includes 100 vitamins, an antidepressant or three, etc.) and who start their medical history with, "Well, you know I was a premature baby. That's when everything started. Well, not everything; the bloody stools didn't start until I ate that chili at my brother in laws. Didn't I tell you about the bloody stools?..." So you must redirect them often - you will learn this skill on Psych as well; it comes in handy in many fields.

Time management also includes all those things you learned as a 3rd year - where to get the labs, when they come back, how to keep your data together, etc. Nothing new for you.

For a 4th year doing a sub-I I'm assuming they're interested in surgery, so I try and find out why, what particularly interests them and make sure that the attending knows (helpful for future LORs). I expect that you will know how a surgery service runs and that you will anticipate needs without being asked - ie, you will write the post-op note, writing some orders (I personally prefer you try, even if you're wrong and I have to change stuff, as it shows initiative), you will have the charts ready for rounds, you will lead us, with the intern to the patients on rounds, etc. and you will teach the 3rd years all of these things. They will be doing some of their first clinical rotations and your student expertise on a surgical service will be useful to them, and I'll be watching to see how you interact with them. I expect you to try and introduce yourself to the patient pre-op, read their chart if you can (I know its hard to do so, especially with first case) and know the indications for the surgery and possible complications. I don't want to see you showboat your knowledge in the OR or treat the students or allied health personnel shabbily.

So you can see there are lots of things important when doing a sub-I; in essence, you should build on the skills you learned as a 3rd year, and function more like an intern. If the service isn't too crazy, you might ask about taking the intern pages for a morning or afternoon. Obviously everything has to be run by your seniors, but it gives you a feel for what life is like and a little independence and time to think about what you would do to respond to the page.

 

[LovelyRita]

For a 4th year doing a sub-I I'm assuming they're interested in surgery, so I try and find out why, what particularly interests them and make sure that the attending knows (helpful for future LORs). I expect that you will know how a surgery service runs and that you will anticipate needs without being asked - ie, you will write the post-op note, writing some orders (I personally prefer you try, even if you're wrong and I have to change stuff, as it shows initiative), you will have the charts ready for rounds, you will lead us, with the intern to the patients on rounds, etc. and you will teach the 3rd years all of these things. They will be doing some of their first clinical rotations and your student expertise on a surgical service will be useful to them, and I'll be watching to see how you interact with them. I expect you to try and introduce yourself to the patient pre-op, read their chart if you can (I know its hard to do so, especially with first case) and know the indications for the surgery and possible complications. I don't want to see you showboat your knowledge in the OR or treat the students or allied health personnel shabbily.

So you can see there are lots of things important when doing a sub-I; in essence, you should build on the skills you learned as a 3rd year, and function more like an intern. If the service isn't too crazy, you might ask about taking the intern pages for a morning or afternoon. Obviously everything has to be run by your seniors, but it gives you a feel for what life is like and a little independence and time to think about what you would do to respond to the page.

Thank you so much, Kim! This is going to be very helpful!