Surgery is boring

[lumbering]

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Bless those people who are willing to grind it out and learn highly technical procedures to solve simple boring problems. You guys must be insane.

P.S. orthopods: try to perfect knee replacement surgery before I need it in 30 years.

 

[Ashers]

P.S. orthopods: try to perfect knee replacement surgery before I need it in 30 years.

those surgeries are fun. 😀 At least not everyone wants to go into ortho (or surgery), or I'd be in trouble.

I found the one thing that made OB/gyn tolerable was scrubbing into gyn surgeries.

 

[Blade28]

Bless those people who are willing to grind it out and learn highly technical procedures to solve simple boring problems. You guys must be insane.

Simple boring problems? 😕

Did you have a very boring G Surg rotation?

 

[Llenroc]

Surgery is pretty dull from the medical student's point of view. You spend a lot of time standing around holding a retractor, while some nasty old man with fat fingers rummages through another man's bowels. Once in a while, they'll demand that you identify something, at which point you lean over another man's shoulder's to look inside a bloody hole at a red tube amongst a bunch of other red tubes. It gets old after the first 5 times you see it, and by your 10th all you can do is watch the needles pile up and pray that it ends within the scheduled 3 hours. Even the "reward tasks" of snipping sutures or stitching the patient up at the end aren't anything to write home about. 😴

A 3rd year surgery resident told me that when he was a medical student, he had "mastered retracting in his sleep", which leads me to believe that even a lot of surgeons don't find these surgeries to be all that interesting.

 

[Ashers]

A 3rd year surgery resident told me that when he was a medical student, he had "mastered retracting in his sleep", which leads me to believe that even a lot of surgeons don't find these surgeries to be all that interesting.

I fell asleep in a cesarean, and yes, I find those surgeries boring. I haven't done gen surg yet. I can only assume it's tons better than C-sections which only were good once I was allowed to tie or suture.

 

[smq123]

I fell asleep in a cesarean, and yes, I find those surgeries boring. I haven't done gen surg yet. I can only assume it's tons better than C-sections which only were good once I was allowed to tie or suture.

I think I was the "black cloud" on L&D. I started to feel lucky if I got a "routine" c-section. During 2 weeks on L&D, I saw:

• 2 abruptions
• a twin pregnancy with one normal fetus, one hydatiform mole
• a woman who coded in the middle of the c-section (you could tell she was becoming hypoxic because the blood that pumped like it was arterial was very, very dark)
• an unexpected breech that refused to come out

"Boring" c-sections were great after a while!

 

[Thievery Corp.]

Boring?? Must be all them residents....
Where I'm at there are no OB/gyn or surgery residents. I've first assisted on 7c-sections this week. I have no desire to do Ob/gyn but this has made it pretty good.

 

[PeeWee137]

I fell asleep in a cesarean, and yes, I find those surgeries boring. I haven't done gen surg yet. I can only assume it's tons better than C-sections which only were good once I was allowed to tie or suture.

wait until you watch 100 lap chole's. half of the dr's dont even let you scrub in, you just stand in the corner and watch on a camera. GOOD TIMES. i hate surgery but i was lucky enough to see some really cool cases and not have the insane q4 for 3 months busy surgery rotation. im glad its over and i plan on never entering an OR again 🙂

 

[Becky]

I will definitely second that...on top of it, I probably have the grand daddy of all of SCUT land. it's only my first week and my legs are burning and I can't even walk when I get home. Lots of scutting and standing in the or. at least youguys have cameras. I just stand in a corner and just try to go to the motions... pretending to see ... then off to the floors for some major scutting.

 

[Ashers]

I think I was the "black cloud" on L&D. I started to feel lucky if I got a "routine" c-section. During 2 weeks on L&D, I saw:

• 2 abruptions
• a twin pregnancy with one normal fetus, one hydatiform mole
• a woman who coded in the middle of the c-section (you could tell she was becoming hypoxic because the blood that pumped like it was arterial was very, very dark)
• an unexpected breech that refused to come out

"Boring" c-sections were great after a while!

I didn't have that bad luck. I had a whole bunch of emergent c-sections, especially at 2am. Then the RNs came to realize there were always c-sections in the middle of the night whenever I was on call.

 

[Leforte]

A surgery rotation as a medical student is nothing like being a surgical resident, nor being an attending. Unlike many aspects of medicine, surgery cannot be learned from a book. Instead, one is slowly mentored through the process in a one-on-one relationship with your attendings. When I was a medical student, I, too, wished I could do a "simple" lap chole, instead of watching it on the screen. Looking back now, I ddn't realize just how much was going on around me. In your medicine rotation, there will be lengthy discussions about the merits/risks of different approaches to a patients management - the same type of decisions are made each minute in the OR (which, BTW, a minute in the OR costs ~$80 to the patient), albeit without many of the lengthy discussions.. - Which pre-op antibiotics do you want? Any steroids? How would you like the tube positioned? Body draped? Where will your incision be? How big will your incision be? Cautery settings? Monopolar or bipolar? Which instruments for this type of a procedure? Will we need frozen sections? What to do when the frozen sections come back? Should we take only half the thyroid or a complete thyroidectomy? Did you find those parathyroids? What type of suture do you want to close with? How do you want to close? Where to send the patient postoperatively? To the floor? Unit? What tests will we need tonight? Tomorrow? How do you want your drains managed? Postop antibiotics? Etc, etc, etc.

No, surgery is not just some highly technical thing for some "simple boring problem." Unfortunately, as a student you really don't get a true feel of what it is all about - until you get there as a resident. There is as much, if not more, decision making that occurs before and after the OR, as occurs in the OR. I wish that we could involve students more in the OR, but reality makes that not possible. When we are closing the neck on a 19 y old female with a thyroid mass, I am sure she does not what the student doing it for the first time - And I can assure you she wants a student no-where near her recurrent laryngeal nerve. When we can - we try to include students as 1st assistants. Routinely, we let sub-I's do trachs, laryngoscopies, etc.

I know that not everyone wants to go into surgery, just as not everyone wants to go into Medicine, Peds, Radiology, Anesthesia, etc. What is important, however, is that as a student you get an appreciation for what each service can offer your patients, and that you learn some basic patient management skills along the way.

At my hospital, every patient with chest pain gets the same work-up - with the goal of <2 hrs to revascularization for a coronary blockage - yet I do insult cardiologists by telling they are following a "highly technical procedure to solve a simple boring problem."

Good luck with the rest of your studies and rotations.

 

[Sureshot83]

Thanks, Leforte, that was a pretty good explanation. At the same time, I think I can see where some of the other students are coming from. (I have not yet done either surgery or Ob/Gyn so I can't really say based on any experience.) I doubt that most 3rd year med students go into the OR really expecting that they will be able to be doing lap choles, no matter how routine they might be. However, if there really is so much complex decision making going on in the OR, it would be probably more interesting if the surgeon could involve the student in that process rather than having them sit in a corner and watch the scope on a monitor. For example, they could be asking/discussing whether they should do a frozen section, which Abx, half or full thyroid, etc.

 

[lumbering]

Did you have a very boring G Surg rotation?

I haven't had my surgery rotation yet.

 

[lumbering]

LeForte: I don't see why you were insulted by my post. It is natural that individuals will disagree about which subjects are interesting. Even though the management of surgical diseases may be complex, I find the diseases themselves to be relatively simple and boring. I personally would rather study complex elegant diseases with simple algorithmic treatments. I don't look down upon surgeons in any way; I simply don't share their interests. I don't expect you to stand in awe of a neurologist ranting about heretible dystonias, and you shouldn't expect me to stand in awe of your surgical skill, knowledge, and instinct. As they say, different strokes for different folks.

I agree with you that surgical experience is important for a medical student who is not going into surgery. I plan to do a neurosurgery elective so that I'll have an idea about surgical treatment options for my future patients. But I won't enjoy it!

 

[smq123]

I haven't had my surgery rotation yet.

If you haven't had your gen surg rotation yet, how do you know that it's boring? 😕

 

[smq123]

Bless those people who are willing to grind it out and learn highly technical procedures to solve simple boring problems. You guys must be insane.

That's what my friend said was the best part of his gen surgery rotation - i.e., they could truly cure people, not just develop long-term management plans. Obviously, not all the time - there are times when even surgery won't help - but enough of the time that he found it rewarding.

Yeah, surgery's not for everyone. But I don't think that they only deal with "simple boring problems." For a lot of patients, surgery is the only thing that will cure them, and I doubt that those patients have simple, straight-forward issues.

 

[Blade28]

Even though the management of surgical diseases may be complex, I find the diseases themselves to be relatively simple and boring.

I think your views might change after your G Surg rotation.

You do realize how incredibly broad the scope of G Surg is, right? I mean, you're talking about anything from cancer to vascular disease; infectious processes to acquired diseases (e.g. from alcohol); endocrine abnormalities to trauma.

 

[elwademd]

A surgery rotation as a medical student is nothing like being a surgical resident, nor being an attending. Unlike many aspects of medicine, surgery cannot be learned from a book. Instead, one is slowly mentored through the process in a one-on-one relationship with your attendings. When I was a medical student, I, too, wished I could do a "simple" lap chole, instead of watching it on the screen. Looking back now, I ddn't realize just how much was going on around me. In your medicine rotation, there will be lengthy discussions about the merits/risks of different approaches to a patients management - the same type of decisions are made each minute in the OR (which, BTW, a minute in the OR costs ~$80 to the patient), albeit without many of the lengthy discussions.. - Which pre-op antibiotics do you want? Any steroids? How would you like the tube positioned? Body draped? Where will your incision be? How big will your incision be? Cautery settings? Monopolar or bipolar? Which instruments for this type of a procedure? Will we need frozen sections? What to do when the frozen sections come back? Should we take only half the thyroid or a complete thyroidectomy? Did you find those parathyroids? What type of suture do you want to close with? How do you want to close? Where to send the patient postoperatively? To the floor? Unit? What tests will we need tonight? Tomorrow? How do you want your drains managed? Postop antibiotics? Etc, etc, etc.

unfortunatley for most students, they are not a part of that conversation. and in not being a part of that conversation, they feel uninvolved. for many students, they show up, see patients, report findings, go to the or to work with people they've never met, to stand and hold a retractor, only to be asked questions about something they can't really see. so, if it is all mentoring that needs to be done in order to learn, then perhaps the mentoring should start with the medical students.

 

[RockShox]

A surgery rotation as a medical student is nothing like being a surgical resident, nor being an attending. Unlike many aspects of medicine, surgery cannot be learned from a book. Instead, one is slowly mentored through the process in a one-on-one relationship with your attendings. When I was a medical student, I, too, wished I could do a "simple" lap chole, instead of watching it on the screen. Looking back now, I ddn't realize just how much was going on around me. In your medicine rotation, there will be lengthy discussions about the merits/risks of different approaches to a patients management - the same type of decisions are made each minute in the OR (which, BTW, a minute in the OR costs ~$80 to the patient), albeit without many of the lengthy discussions.. - Which pre-op antibiotics do you want? Any steroids? How would you like the tube positioned? Body draped? Where will your incision be? How big will your incision be? Cautery settings? Monopolar or bipolar? Which instruments for this type of a procedure? Will we need frozen sections? What to do when the frozen sections come back? Should we take only half the thyroid or a complete thyroidectomy? Did you find those parathyroids? What type of suture do you want to close with? How do you want to close? Where to send the patient postoperatively? To the floor? Unit? What tests will we need tonight? Tomorrow? How do you want your drains managed? Postop antibiotics? Etc, etc, etc.

I will also say that a student can do most of the above if they are open to the experience. When i was on surgery I at least pretended that I was the person making the decisions. I would get two orders sheets so that I could write the post-op orders, I would try to figure out a lot of what you said above on my own then let the resident see them. The first several we redid them (hence the two orders sheets) but within a few days I could do them pretty well. I would try to figure out if this was going to be same-day, overnight, needing a foley or not, arms tucked or outs, stuff like that. This moved to the surgery itself. By paying attention after a few I could anticipate the next instrument better than some of the scrubs, soon I could figure out whether I should burn, tie, or clip a vessels, and etc. It wasn't really me doing these things but by asking the questions in myself I learned.

By two weeks into surgery I was first-assistent on some pretty serious cases, and helped canulate a open-heart, acted as the scrub tech for a few procedures, and overall gained alot of trust. You can do this without even having to speak a lot, just pay attention. It all goes to the best advice I have received about surgery.... You want to be a good surgeon learn how to be a great assistant because if you can anticipate and assist without a hitch you can do the surgery.

So I hope this helps...and btw this formula is what you need to assure yourself of honors...on any rotation.

So perhaps surgery isn't boring maybe you just are.

(what i mean by that is not that you are a boring person (have to add that do to the overly sensitive people in medicine lately) but that you are not applying yourself, perhaps.)

 

[smq123]

So perhaps surgery isn't boring maybe you just are.

But the OP hasn't done his surgery rotation yet. Which still raises the question - how does he know it's boring? Don't knock it till you've tried it.

 

[LuckyBambooGirl]

unfortunatley for most students, they are not a part of that conversation. and in not being a part of that conversation, they feel uninvolved. for many students, they show up, see patients, report findings, go to the or to work with people they've never met, to stand and hold a retractor, only to be asked questions about something they can't really see. so, if it is all mentoring that needs to be done in order to learn, then perhaps the mentoring should start with the medical students.

Are you trying to say the med students should actively try to be mentored? I don't get the sense that the residents really want me to be part of that "conversation." The surgery residents I have worked with so far give me the impression that they do not want me to ask them a bunch of annoying questions, so I just shut up when I am in the OR. I am definitely not going to bother the surgeon while he's operating!

 

[Top Gun]

Are you trying to say the med students should actively try to be mentored? I don't get the sense that the residents really want me to be part of that "conversation." The surgery residents I have worked with so far give me the impression that they do not want me to ask them a bunch of annoying questions, so I just shut up when I am in the OR. I am definitely not going to bother the surgeon while he's operating!

I think what elwademd is saying is that the residents should make more of an attempt to mentor the medical students. Your experience suggests that is indeed the case. Many of us have learned that some surgeons prefer a student to speak only when spoken to, or to be seen and not heard. So more involvement of the student would be beneficial. Of course, this has to be within reason, as there are times when a surgeon is at a critical stage of the procedure, and cannot be bothered too much to pimp students.

 

[getunconcsious]

Bless those people who are willing to grind it out and learn highly technical procedures to solve simple boring problems. You guys must be insane.

P.S. orthopods: try to perfect knee replacement surgery before I need it in 30 years.

LOL...I do pretty much agree. Scrubbing in sucks and the whole thing is BO-RING! I also haven't done surgery but at my institution GYN is pretty much all day OR and I'm guessing that a C-Hyst or a hydatidiform mole has GOT to be better than a lap chole or lap appy.

That said, having had a ruptured appendix at age 14, I'm VERY glad that there are some good surgeons out there. As someone else said, in a lot of cases surgery is the ONLY thing that can cure the person....

 

[SLUser11]

I fell asleep in a cesarean, and yes, I find those surgeries boring. I haven't done gen surg yet.

I haven't had my surgery rotation yet.

I also haven't done surgery but at my institution GYN is pretty much all day OR and I'm guessing that a C-Hyst or a hydatidiform mole has GOT to be better than a lap chole or lap appy.

So can we change the title of this thread to GYN Surgery is boring?

Personally, I hated OB/GYN, both in and out of the OR.....I couldn't stand being there, and was completely bored. And yet, I loved real surgery, and ended up going into general.........so what I'm saying is IT'S NOT THE SAME AND DON'T LUMP US TOGETHER PLEASE.

BTW, props to you guys for completely writing something off before you've actually experienced it.....👍

 

[Ashers]

So can we change the title of this thread to GYN Surgery is boring?

Personally, I hated OB/GYN, both in and out of the OR.....I couldn't stand being there, and was completely bored. And yet, I loved real surgery, and ended up going into general.........so what I'm saying is IT'S NOT THE SAME AND DON'T LUMP US TOGETHER PLEASE.

BTW, props to you guys for completely writing something off before you've actually experienced it.....👍

Just to clarify (since I was quoted up there), and because I'm bored of reading on family practice.

Gyn surgery wasn't bad -- gyn was the most enjoyable part of OB/gyn for me... c-sections were bad between 2 and 4am.

I haven't written off gen surg, I'm looking forward to that rotation... and I think I said gen surg must be better than c-sections, and I have every intention of going into some form of surgery. Every day I'm more and more sure of ortho. =)

 

[getunconcsious]

So can we change the title of this thread to GYN Surgery is boring?

Personally, I hated OB/GYN, both in and out of the OR.....I couldn't stand being there, and was completely bored. And yet, I loved real surgery, and ended up going into general.........so what I'm saying is IT'S NOT THE SAME AND DON'T LUMP US TOGETHER PLEASE.

BTW, props to you guys for completely writing something off before you've actually experienced it.....👍

Yah, but I'm lazy (i.e. Path>>>Psych are my specialty options). Anything with 80 hr workweeks and/or q4 call and/or showing up before 7 am is a write-off. Nothing is SO great that it's worth meeting the above criteria for. I don't have to experience something that meets the above criteria to know that it sucks. Sorry to inform you, but some of us have a work ethic that is, well, for $hit. And I'm not the only one...you know who you are, lifestyle peeps!

 

[elwademd]

Are you trying to say the med students should actively try to be mentored? I don't get the sense that the residents really want me to be part of that "conversation." The surgery residents I have worked with so far give me the impression that they do not want me to ask them a bunch of annoying questions, so I just shut up when I am in the OR. I am definitely not going to bother the surgeon while he's operating!

i'm not a surgeon, so my memory of my surgery rotation was only when i was in medical school. the only or question i remember being asked was "do you know what field you want to go into?" my reply was "internal medicine." there were no questions after that! it didn't bother me, as i didn't want to go into surgery, and appreciated seeing patients in their rooms, doing pre-op evals, etc. i saw enough, and appreciated the experience. i didn't find it boring though as i was able to find the "internal medicine" aspects of general surgery. i knew what i wanted out of my general surgery rotation, and thus aimed to get that experience.

but what should a student who doesn't know what he/she wants do during their general surgery rotation? my thinking is that many students feel that the rotation is boring because they're not involved... or at least they don't feel involved. given the students' level of knowledge and ability, discussing how/why is likely the most appropriate way in which to give students some level of involvement. otherwise, i'm not sure how students can get more involved on the o.r. side of things.

that's why i brought up that perhaps someone, whether it be an attending or a resident, should go over the decision making process with a medical student- whether it be before the case, during the case, or after the case.

 

[Leforte]

There are many times in the OR where a student can be proactive.

1) Before the case, when the resident is putting up films - ask to go over them. Better yet, say something like "I'm still having some trouble finding things on CT's, but what I am seeing on this patient's films is..."

2) When we're closing, ask what decisions were made. A good way of doing this could be, "When we were taking out a portion of that colon, we stopped at the decending colon - when would we take out more?" or, "Your closing deep layers with 3-0 vicryl, and skin with 4-0 prolene - what's the difference between them", or "We chose Ancef as our preoperative antibiotics, would we choose something else if the patient was allergic to penicillins?", etc, etc. If you've done this a few times, the resident will get the feeling you are interested and will most likely let you in on other portions, like suturing!

3) After you've ran out and got the bed, ask if you can try to write orders. Something like, "What's your pneumonic for orders? I can't seem to remember everything when I am writing them." BTW a good one is ADC VAN DIML (admission, diagnosis, condition, vitals, activity, nursing [foley, drains, etc], IVF, Meds, Labs).

To be honest, I would estimate that maybe 30-40% of students really show interest in learning in the OR. Many are just trying to get through the rotation to move on to other things - and that's cool. As has been said before - we don't expect everyone to love it. But at the same time, plenty of students have shown up to cases completely unprepared and my philosophy has been that if you don't take initiative for your own education, I am not going to force feed it into you.

Also, remember that the residents/attendings all know each other pretty well (at least we do in my department). I can see that how at times a student can feel "out of the mix" - but we really do enjoy when students contribute to things/discussions, both professionally and otherwise.

Anyway, plenty of other suggestions for another time.

Regards

Leforte

 

[mules05]

2) When we're closing, ask what decisions were made. A good way of doing this could be, "When we were taking out a portion of that colon, we stopped at the decending colon - when would we take out more?" or, "Your closing deep layers with 3-0 vicryl, and skin with 4-0 prolene - what's the difference between them", or "We chose Ancef as our preoperative antibiotics, would we choose something else if the patient was allergic to penicillins?", etc, etc. If you've done this a few times, the resident will get the feeling you are interested and will most likely let you in on other portions, like suturing!

Would questions like this really be appreciated? Despite being interested, I tend not to ask things like this because, really, any book or quick internet search will give me the answer. I guess I feel like I'd rather be seen as disinterested than dumb. I mean, if someone asked about whether you'd give something other than ancef in a pen-allergic patient, wouldn't you be wondering whether they paid any attention in pharm? To me these questions come off as the student being either 1) dumb or 2) sucking up.

 

[mfreema1]

Would questions like this really be appreciated? Despite being interested, I tend not to ask things like this because, really, any book or quick internet search will give me the answer.

Those kinds of questions are regarding medical managment. You can find the "textbook answer" - but each patient is different. Often you'll find that they deviate from the "textbook answer" - and that's your clue to inquire why they're doing something differently. You can speculate as to why, and then ask "are we doing X instead of Y because of Z? Could you explain that? Thanks!" in a non-pimp-your-resident sort of way. I'd say that well over 50% of the patients I saw on gen surg, gyn surg, & trauma had plans that weren't directly textbook. So it's helpful to know the textbook treatments, because then when decisions are made to deviate from that, you can recognize that deviation and figure out why the customization happened.

 

[Leforte]

Actually, I give Ancef all the time to "PCN allergic" patients -- (actually I have anesthesia do it🙂)... When I ask the allergy, they'll say "I don't know, but I've always been told to say it." Give a test dose once they've been intubated, and there you go. If someone has a true allergy, they'll be able to tell you what it is. Also, there are specific guidelines for surgical patients that I definitely never learned in Pharm - but maybe they're teaching it now.

As far as knowing how much colon to be resected for a given cancer - that is definitely resident + level of knowledge, won't be tested on your shelf, but is still cool to know - and personally I would spend my study time as a student reading more basic management stuff in preparation for shelf/board exams. Also, as indicated earlier, textbook answers are often 5-10 years away from current management, and patients treatment course can differ significantly.

One can look anything up in texts, so I guess the argument could be why ask anything! But good residents/attendings enjoy teaching, and our teaching students/interns/junior residents is a way to reinforce our own knowledge.

As far as sucking up - I don't consider questions at appropriate times sucking up. Things that do suck are: Non-stop questions in the middle of rounds - very annoying, Being unprepared for a case, then try to get over - sucking up. Sabotaging a fellow student - setting yourself up to fail. --- you get the drift.

 

[Winged Scapula]

Actually, I give Ancef all the time to "PCN allergic" patients -- (actually I have anesthesia do it🙂)... When I ask the allergy, they'll say "I don't know, but I've always been told to say it." Give a test dose once they've been intubated, and there you go. If someone has a true allergy, they'll be able to tell you what it is. Also, there are specific guidelines for surgical patients that I definitely never learned in Pharm - but maybe they're teaching it now.

I would love to do that, as I agree with you...most "allergies" are not real ones but rather an expected or common reaction to the medication (ie, nausea). However, with all the trouble I would get from every body and their brother asking, "Are you aware this patient has an allergy to PCN?" and a call from the pharmacy asking the same, it hardly seems worth the trouble (mind you I am also not a fan of giving ABX anyway for clean or CC cases).

 

[Blade28]

While it's true that most patient-reported allergies are side effects (nausea, fatigue, etc.), it's going to be hard to defend if something bad happens and there's a documented allergy to the med you just administered.

 

[Leforte]

I agree - and would never give a cephalosporin to a true PCN allergic pt, but when someones allergy is "I don't know" I think their risk is far greater to have c-diff and its associated morbitity from post-op Clindamycin than a test dose of a cephalosporin to an already intubated patient. Our hospital allows it in the OR in a patient who does not have a history of rash/anaphylaxis. A test dose will show cutaneous symptoms in a true allergic patient, and the airway is obviously controlled.

But we digress from the OP's topic.

The point of this is - if the student had asked this type of question, this could possibly have made their surgery rotation less boring and more interactive - and hopefully they can appreciate that surgeons aren't merely technicians to boring problems (well, most of the time anyway!). Also, to point that not every clinical decision on the wards is necessarily what is taught in Pharm class, etc. We all develop our own style/method of practice throughout our training from all clinical experiences - even the boring ones.

Leforte