Switching specialty due to learning style?

[BellaBlue22]

Brand new gen Surg intern here. I was told repeatedly that I was "way too nice" to be a surgeon. Admittedly, I've been irked by 95% of the personalities I've encountered in surgery. But somehow, I loved the OR enough to press on.

Now, a new concern has come to light. I think the ridiculous tantrums my seniors and attendings throw are nauseating, and I don't care about them on a conscious level. But... I also don't learn when I'm being pimped and screamed at. I also find that I can't recall information in such an environment. Ditto for trying to watch and pick up on procedures. It's not that I'm sobbing in the corner scared, it's just that I somehow focus more on the anger than the actual right answer, leaving me in a perpetual state of "wait a second, WHAT was that again?!" In addition, I can read about a procedure and then go see one, but still end up feeling lost unless someone is talking me through the steps. Obviously, a steady stream of questions isn't usually well-received, but that's what it would take for me to really understand what's going on. The same goes for stupid things like draping: I'm supposed to pick up on it by watching once, but then when I try and position my hand the wrong way or something, I get yelled at and still don't quite understand what I did. I need to try things a couple of times in a low-pressure environment if I'm really going to get them down pat. It doesn't need to be outside the OR (although a couple of dry runs would be ideal) I just need someone there who will be a little nicer about it if I'm going to do any actual learning.

I'm "book smart," 260's on both steps and AOA, but I honestly worry that I may have a learning disability that will make it impossible for me to learn surgery. The "see one, do one, teach one" method just isn't cutting it. Oddly, I still find that I love the OR (although, increasingly, I'm getting a bit of "fear response" when I'm there.) I would still like to stick with surgery, but fear that I'm not teachable. Do I need to see about switching, and if so... What next?

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[bashwell]

Brand new gen Surg intern here. I was told repeatedly that I was "way too nice" to be a surgeon. Admittedly, I've been irked by 95% of the personalities I've encountered in surgery. But somehow, I loved the OR enough to press on.

Now, a new concern has come to light. I think the ridiculous tantrums my seniors and attendings throw are nauseating, and I don't care about them on a conscious level. But... I also don't learn when I'm being pimped and screamed at. I also find that I can't recall information in such an environment. Ditto for trying to watch and pick up on procedures. It's not that I'm sobbing in the corner scared, it's just that I somehow focus more on the anger than the actual right answer, leaving me in a perpetual state of "wait a second, WHAT was that again?!" In addition, I can read about a procedure and then go see one, but still end up feeling lost unless someone is talking me through the steps. Obviously, a steady stream of questions isn't usually well-received, but that's what it would take for me to really understand what's going on. The same goes for stupid things like draping: I'm supposed to pick up on it by watching once, but then when I try and position my hand the wrong way or something, I get yelled at and still don't quite understand what I did. I need to try things a couple of times in a low-pressure environment if I'm really going to get them down pat. It doesn't need to be outside the OR (although a couple of dry runs would be ideal) I just need someone there who will be a little nicer about it if I'm going to do any actual learning.

I'm "book smart," 260's on both steps and AOA, but I honestly worry that I may have a learning disability that will make it impossible for me to learn surgery. The "see one, do one, teach one" method just isn't cutting it. Oddly, I still find that I love the OR (although, increasingly, I'm getting a bit of "fear response" when I'm there.) I would still like to stick with surgery, but fear that I'm not teachable. Do I need to see about switching, and if so... What next?

Love the OR, but need people who are "nicer" teaching you, maybe anesthesiology would suit you?

 

[Winged Scapula]

So let me get this straight:

you think you might have a learning disability because you're struggling 3 weeks into internship and people are screaming at you?

The problem isn't you or surgery. It's this program.


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[Auvelity]

At first it will be hard. But soon you'll make less and less mistakes and be able to go pass your attendings and seniors tantrums and be able to enjoy the good stuff that attracted you to surgery on the first place

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[QofQuimica]

So let me get this straight:

you think you might have a learning disability because you're struggling 3 weeks into internship and people are screaming at you?

The problem isn't you or surgery. It's this program.

Agree.

Look, a lot of people struggle in a situation like that. My dad tried to teach me to drive when I was 16, and suffice it to say that his "teaching style," which consisted of yelling at me when I did something wrong, wasn't very successful because it just made me even more anxious. I took a driver's ed class and had no problems learning to drive when someone else who didn't yell at me walked me through the steps. It's not exactly rocket science once you understand what you're doing and why.

So here's what you need to do. Come in a little early or stay a little late one day, and get one of your junior/senior residents or even a sympathetic scrub nurse to go through the steps of draping with you. You need a couple of dry runs so you can get the steps down, just like you said. For the procedures, definitely make sure you've read up about them ahead of time (and ideally watch a video or two on YouTube; they show you how to do just about every procedure imaginable on there nowadays).

As for switching specialties, well, if you truly love surgery (which it sounds like you do), then don't give up because a few of your seniors are behaving badly. None of what you're learning to do in the OR is rocket science, either. And a lot of the hazing you get as a junior trainee is because people want to test your mettle. Not that it makes it right, but it's just how it is sometimes. I guarantee you that no one there is shocked that an intern in July isn't doing everything exactly perfectly. They didn't do everything perfectly as new interns either. They got better with experience, and so will you. That being said, remember how you're feeling right now, and don't do the same thing to *your* interns next July.

 

[Grazia Lamberti]

Thanks to those who replied. The reason I'm concerned that I might be part of the problem is that for some reason, I have a really hard time applying/doing what I'm told. For example, in med school I was always told to cut suture a certain way, which is different than how they want it done here. Old habits die hard, so even though I know their way, I'll accidentally default back to my old way often. This is especially true if I'm either nervous, trying to think through pimp questions or trying to pay attention to what's going on with the procedure as a whole. It comes across as me "not listening," but this isn't the case- I'm listening too much to too many things- and evidently not always the right things. This leads me to another problem- I'll get in trouble for not knowing what kind of suture to use for a certain step, or something like that, because "we've done this procedure before." Well, yes, but I'm still trying to wrap my head around the mechanics/anatomy. I only just figured out that I need to pull up old op notes for the same procedure and memorize them beforehand. But if you multiply this by 3 procedures/day, plus reviewing anatomy, physio, complications, and pre-rounding, you're looking at 2 hours of sleep per night. I tolerate sleep deprivation really well, but believe me, it's not making me any smarter.

It seems like the expectation is that you'll read enough to cause you to just show up and be able to do surgery. My attending is forever on a soapbox about how millennials want to be spoon fed information. But without someone to walk me through cases verbally while letting me do it (without yelling!) I am really doubtful that I can become competent.


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[BobBarker]

It's ok. It will only get better.

 

[hallowmann]

Thanks to those who replied. The reason I'm concerned that I might be part of the problem is that for some reason, I have a really hard time applying/doing what I'm told. For example, in med school I was always told to cut suture a certain way, which is different than how they want it done here. Old habits die hard, so even though I know their way, I'll accidentally default back to my old way often. This is especially true if I'm either nervous, trying to think through pimp questions or trying to pay attention to what's going on with the procedure as a whole. It comes across as me "not listening," but this isn't the case- I'm listening too much to too many things- and evidently not always the right things. This leads me to another problem- I'll get in trouble for not knowing what kind of suture to use for a certain step, or something like that, because "we've done this procedure before." Well, yes, but I'm still trying to wrap my head around the mechanics/anatomy. I only just figured out that I need to pull up old op notes for the same procedure and memorize them beforehand. But if you multiply this by 3 procedures/day, plus reviewing anatomy, physio, complications, and pre-rounding, you're looking at 2 hours of sleep per night. I tolerate sleep deprivation really well, but believe me, it's not making me any smarter.

It seems like the expectation is that you'll read enough to cause you to just show up and be able to do surgery. My attending is forever on a soapbox about how millennials want to be spoon fed information. But without someone to walk me through cases verbally while letting me do it (without yelling!) I am really doubtful that I can become competent.


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That's not a learning disability or something wrong on your side. That's basically normal. My only suggestion might be to repeatedly practice cutting sutures the way they do it at your hospital on downtime, if any exists...

This really sounds like an issue with the program/attendings. You're not going to know everything a few weeks in. You try. You fail. You try again. I've seen surgeons treat July interns way better than what you're describing.

Just work hard and keep it up. Maybe get a feel for how other interns are dealing. Maybe they feel the same way you do (or maybe they do, but won't admit it).

 

[Merely]

Your attendings are complete dinguses and this is one of the reasons that the best and brightest arent going into surgery anymore. Theres no reason for them to go somewhere where theyre going to be treated like slaves and berated all day when they can become GIs or Cardios and make more with less pain.

 

[Psai]

Lots of videos on surgery online. One of the best residents I've had would read up on technique and watch videos before surgery so that he would know what to do. I'm sure that took a ton of preparation but you can see the difference it makes when the attendings trust that you know what you're doing and let you take the helm.

 

[Promethean]

As others have said... it isn't you.

To some degree, it is hazing. A lot of surgeons were treated this badly when they were interns. They think that it is part of the learning process and they pass it on to you. I've had a few attendings explain that if they aren't awful to the interns, how can they expect to teach them to be good surgeons. If they go out and kill someone, that would be their fault for not humiliating, belittling, degrading, and abusing them enough when they were learning.

It is an unfortunate part of the culture of surgery. One of the OR nurses who trained me did that to new nurses, too. I cried every night for the weeks that I was on her service... but within a few months after I was off orientation, I was one of the few of the younger nurses that she trusted with some of her bigger cases. It wasn't because I was especially awesome, but that I kept trying to keep up with her demands and to let her vicious criticisms slide off me. I could have learned more from her if she'd been less abusive, but there was no way to make her see/believe that.

It does get better. You will have to adapt a little, and they will start to lighten up as they get to know you as a person and a competent physician not as just one of the new crop of punching bags. In any case, you are here for a while... it is just the first few weeks. May as well settle in, give it your best, try to find those opportunities to practice what they want you to know on the side, and make time for your mental and physical well-being. Find a trustworthy confidante, whether a counselor or a pastor or someone that you can talk to, who can help you find perspective.

You got this far. You can see it through. Feeling as though you can't is just part of it, and a temporary part at that.

 

[ProfMD]

I am sorry that you are going through this. Not all surgeons are this way. Hopefully there are others in your program who are more reasonable.

The first few months of residency are the toughest. It is the first time you actually have responsibility that affects patient care. You are expected to learn on an entirely new level. And, you are no longer a student, but not yet an attending - it is this weird in-between. Once you get used to the routine, things get better.

Practice, learn from your mistakes, read when you can, but also find time for activities outside of surgery. Try not to worry too much about other people's issues and instead focus on your own education and providing the best care you can for your patients.

The people above you who are a**holes may stay that way, but they may also get better as you get to know them. It is unfortunate that it starts out this way, but it does. Just try not to treat your own interns/juniors this way as you rise in the ranks.

If you truly love surgery, you won't be happy doing anything else. You could try transferring to another program or another surgical discipline. However, 3 weeks in is way to early to make this kind of decision. Stick it out for now and trust that it will get better.

 

[Grazia Lamberti]

As others have said... it isn't you.

To some degree, it is hazing. A lot of surgeons were treated this badly when they were interns. They think that it is part of the learning process and they pass it on to you. I've had a few attendings explain that if they aren't awful to the interns, how can they expect to teach them to be good surgeons. If they go out and kill someone, that would be their fault for not humiliating, belittling, degrading, .

Wow, that's ridiculous. I may be preaching to the choir here, but I'd argue that any knowledge/confidence deficits that trainees leave with are partially the faults of such abusive faculty!

As far as people "lightening up," one of the weirdest things about surgery is how people have no problem letting you know how worthless you are in the OR or on rounds, and then ask you if you want to go grab a beer after work. At first I was like "really? Gee I thought you hated me, but ok...?" Kinda like a social reject on a bad teen movie when the mean popular girl pays attention to them. But lately I've had an increasingly hard time not saying "NO, you're ***** crazy, and we are NOT friends."

The fact of the matter is this: very similar to how many gay males used to "hide out" in the priesthood, and people with paranoid personality traits find solace in the CIA, people with narcissistic personality disorder and other psych issues are able to blend in in surgery. It's a shame. My rule of thumb is, the minute it occurs to me that my attending's behavior would buy them a time out in kindergarten, I try to latch on to any medically-relevant thing they're saying and filter out the rest. There is nothing morally wrong with being an intern- remember that. Just because you don't know all the answers yet doensn't mean you're lazy or stupid- it just means that you haven't memorized every textbook in the field yet, which is appropriate. Unfortunately, interns are often treated like a group of naughty children, based on the fact that they're interns. You are an adult and a physician. Don't forget that.




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[doc05]

1. your program sucks. they should not treat july interns that way.
2. remember from the attending's perspective, the patient is at stake. one day you will be on your own, so everything needs to be learned right.

 

[QofQuimica]

As far as people "lightening up," one of the weirdest things about surgery is how people have no problem letting you know how worthless you are in the OR or on rounds, and then ask you if you want to go grab a beer after work. At first I was like "really? Gee I thought you hated me, but ok...?" Kinda like a social reject on a bad teen movie when the mean popular girl pays attention to them. But lately I've had an increasingly hard time not saying "NO, you're ***** crazy, and we are NOT friends."

You don't have to be friends with all the other residents. You just have to be able to work together. That being said, I wouldn't go out of your way to antagonize anyone, either. People get that you'll be busy as a surgery resident, so you won't have to spend a lot of time hanging out with your co-residents. But if your whole intern class is getting together, go out with them once on a while. It may help grease the wheels socially, and you may find someone in the group who you actually like. Even if you don't drink, you have to eat dinner anyway: go to the bar once in a while and get some food.

 

[Apollyon]

Wait - why is the OP "BellaBlue" and "GratziaLamberti" responding as if she is the OP?

 

[Grazia Lamberti]

Wait - why is the OP "BellaBlue" and "GratziaLamberti" responding as if she is the OP?

Not the OP, just a fellow intern in a similar situation. The previous posters' comments resonated with me as well- didn't mean to make it the "me" show. I don't always pay the closest of attention to my wording and grammar on here. I'm sure my attendings would say that this makes me a morally inferior individual who is lazy and an idiot;-)

 

[Merely]

Wait - why is the OP "BellaBlue" and "GratziaLamberti" responding as if she is the OP?

Good catch

 

[hamstergang]

Wait - why is the OP "BellaBlue" and "GratziaLamberti" responding as if she is the OP?

You really think these sound like they're coming from the same person?

I somehow focus more on the anger than the actual right answer, leaving me in a perpetual state of "wait a second, WHAT was that again?!"

My rule of thumb is, the minute it occurs to me that my attending's behavior would buy them a time out in kindergarten, I try to latch on to any medically-relevant thing they're saying and filter out the rest.

 

[Apollyon]

You really think these sound like they're coming from the same person?

There's not enough of a sample there for me to draw such a conclusion. If your forensic skills are that good, I sincerely applaud you.

 

[Grazia Lamberti]

Alas, unlike OP, I can't even spell "AOA." Or (how's this for a plot twist) since our experiences are so similar, maybe we ARE the same person and don't know it, a la Fight Club. Sleep deprivation is a helluva drug...


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[IslandStyle808]

260 and AOA. You don't have LD. If you did, it would have show up in medical school or much before that (i.e. grade school)...

 

[exsanguination]

Your attendings are complete dinguses and this is one of the reasons that the best and brightest arent going into surgery anymore. Theres no reason for them to go somewhere where theyre going to be treated like slaves and berated all day when they can become GIs or Cardios and make more with less pain.

I want to re-iterate this post especially in light of general surgery's dismal match numbers last year. General surgery is doomed to become a field of IMGs and this problem will become even worse. Their pay ****, the hours are ****, and clearly the attitude and demeanor of the specialty as a whole is ****.

Winged Scapula - you are obviously a huge exception to this pattern, but even you know that there is so much truth in the post I quoted!

 

[SierraMist14]

God. This is part of the reason why I didn't do surgery. I absolutely love the OR, but can't deal with that culture. OP, it's still early and all of us interns are still f*cking up (I know I am). It should get better.

 

[exsanguination]

260 and AOA. You don't have LD. If you did, it would have show up in medical school or much before that (i.e. grade school)...

I'd argue that there's a difference in types of learning. At my school some of the AOAs were clinically just not the best, but they received AOA because my school put an absurd amount of weight onto the shelves and step 1. That only reflects the ability to memorize and regurgitate, not necessarily procedural learning, critical thinking, efficiency, and interpersonal interaction intelligence, which are absolutely necessary to succeed as a clinician.

 

[Winged Scapula]

I want to re-iterate this post especially in light of general surgery's dismal match numbers last year. General surgery is doomed to become a field of IMGs and this problem will become even worse. Their pay ****, the hours are ****, and clearly the attitude and demeanor of the specialty as a whole is ****.

Winged Scapula - you are obviously a huge exception to this pattern, but even you know that there is so much truth in the post I quoted!

"Dismal match rate"?

"Pay ****"?

"Hours are ****"?

"Attitude and demeanor of the specialty as a whole is ****"?


I have no disagreement in that it sounds as if the OP is in an unpleasant program but there's a lot of broad generalizations and even inaccuracies in your comments above. Surgery is not for everyone but there are plenty of programs without such unpleasant training, hours in and out of training have significantly decreased as more surgeons become employees while the number of applications have increased (as has the program fill rate) and the pay and practice can be quite rewarding. I'm not a "huge exception".

 

[IslandStyle808]

I'd argue that there's a difference in types of learning. At my school some of the AOAs were clinically just not the best, but they received AOA because my school put an absurd amount of weight onto the shelves and step 1. That only reflects the ability to memorize and regurgitate, not necessarily procedural learning, critical thinking, efficiency, and interpersonal interaction intelligence, which are absolutely necessary to succeed as a clinician.

Fair point, the 260 and AOA can be non factors and people have different modes of learning. In the end, this person finished medical school, most likely did well on her rotations, and did well on her interviews (clinically competent enough). If she had LD, this would have definitely shown up in medical school at the very least and if not sooner.

 

[QofQuimica]

I have no disagreement in that it sounds as if the OP is in an unpleasant program but there's a lot of broad generalizations and even inaccuracies in your comments above. Surgery is not for everyone but there are plenty of programs without such unpleasant training, hours in and out of training have significantly decreased as more surgeons become employees while the number of applications have increased (as has the program fill rate) and the pay and practice can be quite rewarding. I'm not a "huge exception".

Agree that the issue is the program here, not the specialty as a whole.

FWIW, I'm a non-surgeon who expected to merely endure my surgery rotation in med school, but I wound up loving it. I could do without the clinic follow ups, and yeah, the hours were long, and some of the personalities could be....prickly. But some of my experiences in the OR were the kind of quasi-religious experiences that are difficult to even explain to people (especially since I'm not at all religious). So many of the little things, like holding the bowels as they were peristalsing, and watching the arteries pulse together in union were just....beautiful. Seeing a new liver transplant turn from grayish brown to pink as it filled with blood for the first time was absolutely amazing. I feel privileged to have been a part of those cases, and I will carry those experiences with me for the rest of my life. Anyway, while I had no desire to actually be a surgeon, the point is, I totally get why other people would. And you definitely don't have to be a future surgeon to appreciate the beauty of surgery.

 

[RadOncDoc21]

Wow, that's ridiculous. I may be preaching to the choir here, but I'd argue that any knowledge/confidence deficits that trainees leave with are partially the faults of such abusive faculty!

As far as people "lightening up," one of the weirdest things about surgery is how people have no problem letting you know how worthless you are in the OR or on rounds, and then ask you if you want to go grab a beer after work. At first I was like "really? Gee I thought you hated me, but ok...?" Kinda like a social reject on a bad teen movie when the mean popular girl pays attention to them. But lately I've had an increasingly hard time not saying "NO, you're ***** crazy, and we are NOT friends."

The fact of the matter is this: very similar to how many gay males used to "hide out" in the priesthood, and people with paranoid personality traits find solace in the CIA, people with narcissistic personality disorder and other psych issues are able to blend in in surgery. It's a shame. My rule of thumb is, the minute it occurs to me that my attending's behavior would buy them a time out in kindergarten, I try to latch on to any medically-relevant thing they're saying and filter out the rest. There is nothing morally wrong with being an intern- remember that. Just because you don't know all the answers yet doensn't mean you're lazy or stupid- it just means that you haven't memorized every textbook in the field yet, which is appropriate. Unfortunately, interns are often treated like a group of naughty children, based on the fact that they're interns. You are an adult and a physician. Don't forget that.




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I would say this is true for all medical fields... Definitely a lot of "bad apples" out there, maybe surgery has a little bit more.

I hated the OR, mainly because of the Nazi OR techs... I could literally be balled up in a corner with my hands straight up in the air and somehow still not be sterile!

 

[LucidSplash]

Dismal match numbers? There were only 2 Unfilled GS programs in the country this March, and I guarantee you those spots were quickly scooped up in the SOAP. Radiology had 6 Unfilled programs, anesthesia had 23, and internal medicine had 26. I think surgery is doing alright.

http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

Also, please cite your source for ****ty pay. I can show you 5-10 emails from the last week looking for general surgeon with starting pay 350k or above.

I want to re-iterate this post especially in light of general surgery's dismal match numbers last year. General surgery is doomed to become a field of IMGs and this problem will become even worse. Their pay ****, the hours are ****, and clearly the attitude and demeanor of the specialty as a whole is ****.

Winged Scapula - you are obviously a huge exception to this pattern, but even you know that there is so much truth in the post I quoted!

 

[Winged Scapula]

Dismal match numbers? There were only 2 Unfilled GS programs in the country this March, and I guarantee you those spots were quickly scooped up in the SOAP. Radiology had 6 Unfilled programs, anesthesia had 23, and internal medicine had 26. I think surgery is doing alright.

http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdf

Also, please cite your source for ****ty pay. I can show you 5-10 emails from the last week looking for general surgeon with starting pay 350k or above.

Which is actually on the low side in many areas of the country for GS.

 

[thoffen]

Firstly, as others have suggested, you need a much broader time perspective than 3 weeks into internship. You are in trouble if you don't commit to at least this year.

It sounds like you know the right answer and the right technique and yet you always find yourself screwing it up. You want to be aggressive but know it's not your place. You're a nice person, diligent high-achieving student, respectful of the hierarchy and are finding yourself conforming to the less than ideal learning environment you are in. Sounds like you don't know what to do with your aggression. It's hard even to be passive-aggressive toward your supervisors, so you take it out on yourself and blame yourself for other people treating you like crap. I mean, come on, learning disability?

Doesn't mean the right answer is to become aggressive-aggressive. But you should probably find a way to have that aggression validated that's a little healthier.

 

[LucidSplash]

Which is actually on the low side in many areas of the country for GS.

Agreed. These are the lowball numbers of what I've seen. Not ****ty.

 

[RadOncDoc21]

Firstly, as others have suggested, you need a much broader time perspective than 3 weeks into internship. You are in trouble if you don't commit to at least this year.

It sounds like you know the right answer and the right technique and yet you always find yourself screwing it up. You want to be aggressive but know it's not your place. You're a nice person, diligent high-achieving student, respectful of the hierarchy and are finding yourself conforming to the less than ideal learning environment you are in. Sounds like you don't know what to do with your aggression. It's hard even to be passive-aggressive toward your supervisors, so you take it out on yourself and blame yourself for other people treating you like crap. I mean, come on, learning disability?

Doesn't mean the right answer is to become aggressive-aggressive. But you should probably find a way to have that aggression validated that's a little healthier.

Pretty damn insightful!

 

[Thanatos]

Brand new gen Surg intern here. I was told repeatedly that I was "way too nice" to be a surgeon. Admittedly, I've been irked by 95% of the personalities I've encountered in surgery. But somehow, I loved the OR enough to press on.

Now, a new concern has come to light. I think the ridiculous tantrums my seniors and attendings throw are nauseating, and I don't care about them on a conscious level. But... I also don't learn when I'm being pimped and screamed at. I also find that I can't recall information in such an environment. Ditto for trying to watch and pick up on procedures. It's not that I'm sobbing in the corner scared, it's just that I somehow focus more on the anger than the actual right answer, leaving me in a perpetual state of "wait a second, WHAT was that again?!" In addition, I can read about a procedure and then go see one, but still end up feeling lost unless someone is talking me through the steps. Obviously, a steady stream of questions isn't usually well-received, but that's what it would take for me to really understand what's going on. The same goes for stupid things like draping: I'm supposed to pick up on it by watching once, but then when I try and position my hand the wrong way or something, I get yelled at and still don't quite understand what I did. I need to try things a couple of times in a low-pressure environment if I'm really going to get them down pat. It doesn't need to be outside the OR (although a couple of dry runs would be ideal) I just need someone there who will be a little nicer about it if I'm going to do any actual learning.

I'm "book smart," 260's on both steps and AOA, but I honestly worry that I may have a learning disability that will make it impossible for me to learn surgery. The "see one, do one, teach one" method just isn't cutting it. Oddly, I still find that I love the OR (although, increasingly, I'm getting a bit of "fear response" when I'm there.) I would still like to stick with surgery, but fear that I'm not teachable. Do I need to see about switching, and if so... What next?

I'm certain you don't have a learning disability and everyone is teachable, I mean hell if I can learn how to do this I'm fairly convinced anyone can lol! What you're experiencing is what a lot of us went through in the beginning, its of little comfort but if you keep showing up you will start to get the hang of all of this so don't do anything rash just yet.

You have to remember that every year a new group of people who don't know how to prep/drape/operate shows up to learn how to do these things and royally screws it up for a good long time before it starts to come together.....whats amusing (or should be) is the genuine shock that attendings/chiefs and etc continue to exhibit every July. Its not like all of a sudden medical school education has gotten much more practical and the new interns got formal, reinforced instruction on sterile technique and operating strategy instead of the nuances of maple syrup urine disease (still never seen it). Instead you do a 2 month, or in some places as little as a few weeks, of a surgery rotation where everyone just yells at you not to touch anything blue and hold your hands under your nipples but above your belly button and voila you're expected to be an expert July 1st as a surgery intern.

That being said there are some things you can do to minimize your pain....it seems to me that many people starting out prepare for cases but not in a way that sets them up for success. I remember scrubbing my first inguinal hernia as an intern and reading Sabiston and Zollinger.....neither was helpful for this, which seems obvious in retrospect and may seem obvious to more senior people here but as an intern I didn't know that. I spent hours "preparing" for that case and still looked like a giant *****. I had much more success in later years with an atlas like Scott-Connor's Operative Anatomy which walks you through the steps a little better, Mastery is also good, and youtube as much as you can stand just to get a feel for the flow of what you're doing. I thought the ACS journal club articles through Score (from the ACS text book) were quick and easy to read and turned a lot of the "i don't know" into right answers without taking 12 hours to read.

Write out the steps of the operation the night before over and over and over again.....the trick is to make the steps automatic and not over think what you're doing. A lot of the technical aspects of surgery aren't unlike shooting a free throw, it helps to be confident. And even if being confident won't always guarantee that you nail the shot, walking up to the free throw line thinking "zomg what if i miss i'm totally going to miss and lose and oh **** are they yelling again" will certainly NOT help you make the shot.

Knowing the steps cold will help you maintain that focus you're missing even if someone is screaming at you, and I've found being that prepared helps you anticipate what's next a little better anyway and therefore decreases the yelling. After every case write down every step you can think of, how they drape, what sutures they use, how they set up retractors, everything....this will help decrease the yelling. After a couple rounds of the same case you'll find that you're not as lost in there and it won't feel like its just flying by you.

As far as the draping, if my attending was a real jerk about stuff like that I would scrub and start draping and then say to the circulator "oh damn I forgot to page Dr. Asshat will you tell him we're ready for him" then take my sweet time with the nurses learning how to do it. And if its any consolation even as a chief resident I was incapable of putting those stupid leg drapes over the stirrups for colorectal cases.....just couldn't do it....I would try to get it over the foot and the damn thing would never unravel the right way or something. I would stand there and have the scrub put them on, because they're simply not designed properly

 

[filhodeinferno]

Brand new gen Surg intern here. I was told repeatedly that I was "way too nice" to be a surgeon. Admittedly, I've been irked by 95% of the personalities I've encountered in surgery. But somehow, I loved the OR enough to press on.

Now, a new concern has come to light. I think the ridiculous tantrums my seniors and attendings throw are nauseating, and I don't care about them on a conscious level. But... I also don't learn when I'm being pimped and screamed at. I also find that I can't recall information in such an environment. Ditto for trying to watch and pick up on procedures. It's not that I'm sobbing in the corner scared, it's just that I somehow focus more on the anger than the actual right answer, leaving me in a perpetual state of "wait a second, WHAT was that again?!" In addition, I can read about a procedure and then go see one, but still end up feeling lost unless someone is talking me through the steps. Obviously, a steady stream of questions isn't usually well-received, but that's what it would take for me to really understand what's going on. The same goes for stupid things like draping: I'm supposed to pick up on it by watching once, but then when I try and position my hand the wrong way or something, I get yelled at and still don't quite understand what I did. I need to try things a couple of times in a low-pressure environment if I'm really going to get them down pat. It doesn't need to be outside the OR (although a couple of dry runs would be ideal) I just need someone there who will be a little nicer about it if I'm going to do any actual learning.

I'm "book smart," 260's on both steps and AOA, but I honestly worry that I may have a learning disability that will make it impossible for me to learn surgery. The "see one, do one, teach one" method just isn't cutting it. Oddly, I still find that I love the OR (although, increasingly, I'm getting a bit of "fear response" when I'm there.) I would still like to stick with surgery, but fear that I'm not teachable. Do I need to see about switching, and if so... What next?

Don't worry, soon you'll be one of the ones doing the yelling. It is the surgeon circle of life.