Thanks for nothing, surgery

[Fiddlergirl]

Surgery grades for my school came back. Great shelf score, good subspecialty scores, final grade of pass. My general surgery eval was terrible. Well the numbers were, apparently my attending couldn't be bothered to actually write anything besides "read more." There's no point to this thread besides that I had to tell someone that surgery completely surgery screwed me over and I have a policy of not telling anyone at school my grades.
So thank you surgery rotation, for two months of hell culminating in a final "screw you."

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[Deferoxamine]

The Surgery 3rd-year rotation IS stupid. Because you can't do anything. Even the Shelf Exam was ******ed - it had nothing to do with Surgery, but was instead a potpourri of poorly-worded questions rejected from the Medicine, Peds, Neuro, and Ob-Gyn shelf exams.

This particular rotation is a game.

Here are the reasons why I got Honors:
-- I was never late for anything.
-- I never talked about sleep (or lack of). I never said the word "tired".
-- I was super aggressive in the OR when it was time to move/transport the patient, put in the Foley, etc.
-- I made small talk with all the OR nurses
-- Between cases, I would sneak into the lockerroom and raid my secret stash of sandwiches and snacks, and gorge myself until the next 5 hour case.
-- At the time, I had a fleeting interest in going into something surgical, which I brought up to everyone around me almost daily.
-- During cases and especially tricky parts of cases, I kept my mouth shut. Maybe 2 questions asked per case, tops.
-- When the attendings gave me the opportunity to talk (i.e. presentations), I WOULD NOT STFU. Talking talking talking, spewing surgical and medical factoids with a pretty presentation to go with it.
-- And most importantly, I had NO other medical students with me. This was a stroke of luck.

 

[Fiddlergirl]

That's what's so annoying! I was aggressive in the OR, and even managed to intubate someone. Showed up every day early to do the vitals. Asked to do presentations, but everyone always said "We don't have time for a student presentation." I'd be less annoyed if I hadn't asked my residents and attendings for feedback halfway through the month and gotten "Don't change anything, you're doing great!" from the same people who apparently felt I was so sub-par.

 

[Perrotfish]

The Surgery 3rd-year rotation IS stupid. Because you can't do anything. Even the Shelf Exam was ******ed - it had nothing to do with Surgery, but was instead a potpourri of poorly-worded questions rejected from the Medicine, Peds, Neuro, and Ob-Gyn shelf exams.

This particular rotation is a game.

Here are the reasons why I got Honors:
-- I was never late for anything.
-- I never talked about sleep (or lack of). I never said the word "tired".
-- I was super aggressive in the OR when it was time to move/transport the patient, put in the Foley, etc.
-- I made small talk with all the OR nurses
-- Between cases, I would sneak into the lockerroom and raid my secret stash of sandwiches and snacks, and gorge myself until the next 5 hour case.
-- At the time, I had a fleeting interest in going into something surgical, which I brought up to everyone around me almost daily.
-- During cases and especially tricky parts of cases, I kept my mouth shut. Maybe 2 questions asked per case, tops.
-- When the attendings gave me the opportunity to talk (i.e. presentations), I WOULD NOT STFU. Talking talking talking, spewing surgical and medical factoids with a pretty presentation to go with it.
-- And most importantly, I had NO other medical students with me. This was a stroke of luck.

On surgery, even more than other rotations, it seems like your grade is based primarily on your attending's mood. I'm sure that all those things you did didn't hurt, but ultimately I don't think there's any consistent advice you can give that, if followed, would consistently caise other surgery students to
replicate your results.

OP, I think you have the right attitude. You got screwed. The key is to deal with surgeons the same way you would deal with an abusive spouse or an alcoholic family member: admit there was nothing you could have done better, don't blame yourself, and walk away. The only thing you need to learn from surgery is that every 2 am stomach twinge that any patient ever has deserves a surgical consult for r/o SBO. The patient might not need it, but the surgeon always deserves it.

 

[Bartelby]

-- At the time, I had a fleeting interest in going into something surgical, which I brought up to everyone around me almost daily.

I think that's the big one. Once you tell them you want to do psych (like me), I think you can forget about the 'A.' I imagine many of us were on time, polite, didn't complain to anyone in the hospital, and were reasonably knowledgeable. I also know my procedural skills were evaluated as 'superior.' I think being really vocal about wanting to do surgery and how much you like what you're doing makes the difference.

And of course getting a shelf exam score to back those evals up.

 

[Perrotfish]

I think that's the big one. Once you tell them you want to do psych (like me), I think you can forget about the 'A.' I imagine many of us were on time, polite, didn't complain to anyone in the hospital, and were reasonably knowledgeable. I also know my procedural skills were evaluated as 'superior.' I think being really vocal about wanting to do surgery and how much you like what you're doing makes the difference.

And of course getting a shelf exam score to back those evals up.

I'm not even sure pretending to like surgery (or even really liking it) is all that important. I think it's mostly luck of the draw: how good a mood your surgeon is in, how he grades, and how much he actually interacts with students.

I think the most important factor in your surgery grade is where your surgeon is at in the 5 year surgeon marriage cycle. The earlier you are in the cycle the better you do. If you rotate when he's just starting to date a brand new 22 year old you'd be hard pressed not to honor. If you finish 5 years later when the judge has just ruleed on his alimony payments you'll be luck to pass. If you really want to honor find a service where two of the three students just failed and ask to rotate with that surgeon, because he's due to restart the cycle any minute.

 

[RySerr21]

at my school you get to your write your own eval for surgery, haha. I think its too avoid your current situation. Sorry man!

 

[turkeyjerky]

Lol--love it. Dude, sucks you got screwed--it's definitely luck on this one, try not to worry about it too much.

 

[ArcGurren]

I'm not even sure pretending to like surgery (or even really liking it) is all that important. I think it's mostly luck of the draw: how good a mood your surgeon is in, how he grades, and how much he actually interacts with students.

I think the most important factor in your surgery grade is where your surgeon is at in the 5 year surgeon marriage cycle. The earlier you are in the cycle the better you do. If you rotate when he's just starting to date a brand new 22 year old you'd be hard pressed not to honor. If you finish 5 years later when the judge has just ruleed on his alimony payments you'll be luck to pass. If you really want to honor find a service where two of the three students just failed and ask to rotate with that surgeon, because he's due to restart the cycle any minute.

ROFL I love it.

OP, I agree with what's been said... unfortunately for Surgery (and many other rotations for that matter) it's sort of a crapshoot as to what you can do to honor.

 

[Fiddlergirl]

The only thing you need to learn from surgery is that every 2 am stomach twinge that any patient ever has deserves a surgical consult for r/o SBO. The patient might not need it, but the surgeon always deserves it.

I kinda like this. I'm applying to EM, and the surgeons at my school absolutely hate the ED, so that makes me have warm fuzzy feelings about middle of the night acute abdomen consults.

 

[2012mdc]

That's what's so annoying! I was aggressive in the OR, and even managed to intubate someone. Showed up every day early to do the vitals. Asked to do presentations, but everyone always said "We don't have time for a student presentation." I'd be less annoyed if I hadn't asked my residents and attendings for feedback halfway through the month and gotten "Don't change anything, you're doing great!" from the same people who apparently felt I was so sub-par.

That's so much BS. Sounds like you got screwed with someone who just doesn't give honors.

I think that's the big one. Once you tell them you want to do psych (like me), I think you can forget about the 'A.' I imagine many of us were on time, polite, didn't complain to anyone in the hospital, and were reasonably knowledgeable. I also know my procedural skills were evaluated as 'superior.' I think being really vocal about wanting to do surgery and how much you like what you're doing makes the difference.

And of course getting a shelf exam score to back those evals up.

I think that's highly dependent on the attending or program. Ours specifically told us not to fake an interest in a surgical career. The only thing that mattered was your interest in the rotation in terms of learning as much as you can and being active. I told them I was deciding between IM and Rads and it did not affect my eval one bit.

 

[Bacchus]

I hate to see my eval. The clerkship secretary for my rotation site sends an e-mail blast asking for feedback. Great. :\

 

[Perrotfish]

I kinda like this. I'm applying to EM, and the surgeons at my school absolutely hate the ED, so that makes me have warm fuzzy feelings about middle of the night acute abdomen consults.

For bonus points, when they come down act like you're completely unaware that they're on a 28 hour call schedule and you're on a 12 hour shift that started at 7 p.m.. As in "I don't know what you're complaining about, I'm here at 2 a.m. too".

I've seen the nurses do this a few times, and I see no reason why they should have all the fun.

 

[Frozen]

The only thing you need to learn from surgery is that every 2 am stomach twinge that any patient ever has deserves a surgical consult for r/o SBO. The patient might not need it, but the surgeon always deserves it.

WIN

 

[Instatewaiter]

Surgery grades for my school came back. Great shelf score, good subspecialty scores, final grade of pass. My general surgery eval was terrible. Well the numbers were, apparently my attending couldn't be bothered to actually write anything besides "read more." There's no point to this thread besides that I had to tell someone that surgery completely surgery screwed me over and I have a policy of not telling anyone at school my grades.
So thank you surgery rotation, for two months of hell culminating in a final "screw you."

I went to the same school you do. You can fight your grades. This is especially true if you rocked the shelf exam. Fight it and you might bump that pass up to a high pass. You're probably SOL about getting that honors though. I never tried to fight the grades but some people did apparently successfully.

I was thinking about doing surgery until I went through that surgery rotation. It blows my mind that anyone coming from there would opt to do surgery. I am now at a program much more well known yet the surgeons are so much happier and much more approachable. It is like night and day which is surprising. I think we just got stuck with an especially malignant surgery program to rotate through in med school.

 

[Thanatos]

I kinda like this. I'm applying to EM, and the surgeons at my school absolutely hate the ED, so that makes me have warm fuzzy feelings about middle of the night acute abdomen consults.

I knew it!

I know its early in the year, but you will see this is not specific to surgery. Just wait until ob-gyn If you approach this logically though, if all students get screwed at some point (and they all do) but almost everyone still gets into residency....it probably doesn't matter.

Seriously though my worst grade was in neurology...my attending was just kind of a bitch and well all got bad grades. But I hated neurology, so not a single **** was given.

 

[45408]

On surgery, even more than other rotations, it seems like your grade is based primarily on your attending's mood. I'm sure that all those things you did didn't hurt, but ultimately I don't think there's any consistent advice you can give that, if followed, would consistently caise other surgery students to
replicate your results.

OP, I think you have the right attitude. You got screwed. The key is to deal with surgeons the same way you would deal with an abusive spouse or an alcoholic family member: admit there was nothing you could have done better, don't blame yourself, and walk away. The only thing you need to learn from surgery is that every 2 am stomach twinge that any patient ever has deserves a surgical consult for r/o SBO. The patient might not need it, but the surgeon always deserves it.

Clearly an adult coping mechanism. You're acting like a big baby.

I kinda like this. I'm applying to EM, and the surgeons at my school absolutely hate the ED, so that makes me have warm fuzzy feelings about middle of the night acute abdomen consults.

Oh, there's two of you.

 

[ArcGurren]

Clearly an adult coping mechanism. You're acting like a big baby.


Oh, there's two of you.

Come on man, there ARE some dickish surgeons.

 

[2012mdc]

Come on man, there ARE some dickish surgeons.

That doesn't mean returning the favor is the right move.

 

[45408]

Come on man, there ARE some dickish surgeons.

So? You're ensuring that there are going to be a lot more of them if you order an inappropriate consult at a terrible time because you're trying to prove something. I rarely invoke Burnett's Law, but that does make you a bad doctor.

"Some dickish surgeons" is not at all the same as "every surgeon deserves it." Perrotfish is just being ridiculous with that kind of commentary.

 

[Perrotfish]

So? You're ensuring that there are going to be a lot more of them if you order an inappropriate consult at a terrible time because you're trying to prove something. I rarely invoke Burnett's Law, but that does make you a bad doctor.

"Some dickish surgeons" is not at all the same as "every surgeon deserves it." Perrotfish is just being ridiculous with that kind of commentary.

It was a joke, I won't be calling for surgical consults just to F- with surgeons. I was serious that I don't think students should internalize any criticism from surgery rotations though. The people do tend to have bad personalities (which it both selects for and then, subsequently, creates) and the students aren't really evaluated on anything anyway because modern surgery doesn't let you do much of anything that you could be evaluated on. Unless you're on a medicine-ish surgical rotation like SICU or transplant chances are the time you spend in the hospital on surgery is going to be a waste.

 

[45408]

because modern surgery doesn't let you do much of anything that you could be evaluated on. Unless you're on a medicine-ish surgical rotation like SICU or transplant chances are the time you spend in the hospital on surgery is going to be a waste.

We didn't all do surgery at Ochsner. I had a pretty different experience than you did as an M3.

 

[Perrotfish]

We didn't all do surgery at Ochsner. I had a pretty different experience than you did as an M3.

I've rotated through 5 major hospital systems: 1 military, 1 private (ochsner), 1 rural, 1 academic, and 1 charity. I did surgery in 2 of them, surgical GYN in another, and I know plenty of people who did surgery in the other two systems. Modern medicine is what it is and most medical students don't do anything in surgery other than retract and maybe close. It's no one's fault, it's just that the modern, very legally influenced opinion is that modern medicine is that students should be playing doctor rather than actually doing anything. If you're on a medical-ish rotation that works out fine, since it's easy for the residents to duplicate your work (you round on the patients, write a fake note and fake orders, and then the resident does it for real). However in surgery there's no real way to fake doiing surgery, so medical students just stand there and retract. If you're on a surgical service that spends all day in the OR that just doesn't leave a lot to evaluate you on. Maybe pimp questions, I guess, but I haven't met many surgeons (or anyone, really) who can concentrate on a fine motor skills task like surgery and also belt out the questions for medical trivial pursuit.

 

[drizzt3117]

Different institutions are different... I did surgeries from start to finish as a m3, at our institutions 4th years regularly do lap choles, my friend told me she did an open chole last week... It's very program and attending dependent.

I've rotated through 5 major hospital systems: 1 military, 1 private (ochsner), 1 rural, 1 academic, and 1 charity. I did surgery in 2 of them, surgical GYN in another, and I know plenty of people who did surgery in the other two systems. Modern medicine is what it is and most medical students don't do anything in surgery other than retract and maybe close. It's no one's fault, it's just that the modern, very legally influenced opinion is that modern medicine is that students should be playing doctor rather than actually doing anything. If you're on a medical-ish rotation that works out fine, since it's easy for the residents to duplicate your work (you round on the patients, write a fake note and fake orders, and then the resident does it for real). However in surgery there's no real way to fake doiing surgery, so medical students just stand there and retract. If you're on a surgical service that spends all day in the OR that just doesn't leave a lot to evaluate you on. Maybe pimp questions, I guess, but I haven't met many surgeons (or anyone, really) who can concentrate on a fine motor skills task like surgery and also belt out the questions for medical trivial pursuit.

 

[Fiddlergirl]

I was waiting for this thread to go south. That actually took longer than I thought it would. Thanks to the first couple of people who posted with support, I appreciate it. Signing off.

 

[ArcGurren]

So? You're ensuring that there are going to be a lot more of them if you order an inappropriate consult at a terrible time because you're trying to prove something. I rarely invoke Burnett's Law, but that does make you a bad doctor.

"Some dickish surgeons" is not at all the same as "every surgeon deserves it." Perrotfish is just being ridiculous with that kind of commentary.

Lol relax I'm well aware what he said was ridiculous. I was being more tongue-in-cheek with my comment.

 

[ArcGurren]

Wow, you really took that comment personally. TheProwler, I'm an M3 who had a bad experience on surgery and is whining about on an online forum. Why do you care? Did I say all surgeons were jerks? No. I actually thought my trauma surgery attendings were great and I learned a lot. I said I was upset because after two straight months of surgery I got a one word evaluation. Don't take these things so personally. It's studentdoctor.net, not a professional evaluation of the surgery profession as a whole.

I dont think anyone is denying that the attending was a dick for going you that eval. But I'm sure you can understand why TheProwler, a surgery resident, would probably be annoyed at the idea of someone calling a late night consult just to screw with the surgeons.

By the way, I've def seen ED residents just call consults for no reason other than to shuffle off a chief complaint. Without reading the charts.

 

[drizzt3117]

I dont think anyone is denying that the attending was a dick for going you that eval. But I'm sure you can understand why TheProwler, a surgery resident, would probably be annoyed at the idea of someone calling a late night consult just to screw with the surgeons.

By the way, I've def seen ED residents just call consults for no reason other than to shuffle off a chief complaint. Without reading the charts.

Or order ct/MRI of the abdomen for abd pain... Not that ill complain about that too much on call soon, "Neg acute, unremarkable ct scan of the abdomen, I would appreciate clinical follow-up" doesn't take too long to dictate.

 

[ArcGurren]

Or order ct/MRI of the abdomen for abd pain... Not that ill complain about that too much on call soon, "Neg acute, unremarkable ct scan of the abdomen, I would appreciate clinical follow-up" doesn't take too long to dictate.

My personal favorite is calling consult on r/o appendicitis without knowing that the person recently had an appy done. Fail much?

 

[45408]

I've rotated through 5 major hospital systems: 1 military, 1 private (ochsner), 1 rural, 1 academic, and 1 charity. I did surgery in 2 of them, surgical GYN in another, and I know plenty of people who did surgery in the other two systems. Modern medicine is what it is and most medical students don't do anything in surgery other than retract and maybe close. It's no one's fault, it's just that the modern, very legally influenced opinion is that modern medicine is that students should be playing doctor rather than actually doing anything. If you're on a medical-ish rotation that works out fine, since it's easy for the residents to duplicate your work (you round on the patients, write a fake note and fake orders, and then the resident does it for real). However in surgery there's no real way to fake doiing surgery, so medical students just stand there and retract. If you're on a surgical service that spends all day in the OR that just doesn't leave a lot to evaluate you on. Maybe pimp questions, I guess, but I haven't met many surgeons (or anyone, really) who can concentrate on a fine motor skills task like surgery and also belt out the questions for medical trivial pursuit.

You could always scrub in a few cases, then go see clinic patients, do hospital consults, and do post-op checks. For anyone not going into surgery, seeing surgery clinic and doing surgical consults will still be useful. Our students always tend to load up their days with cases and do little else, but that's certainly not because tell them that's what they should do. Most of our attendings have at least 2 days of clinic and are more than happy to have students/residents work with them.

Having students do a fair amount of a procedure is an expensive OR endeavor. The cost of OR time that I've heard quoted is $60/minute. Why bother letting someone close skin if they have no interest in a surgical specialty or even a specialty where they would have to suture at all? It'll cost an extra $300, every single time.

TheProwler, I'm an M3 who had a bad experience on surgery and is whining about on an online forum.

Clearly.

 

[45408]

My personal favorite is calling consult on r/o appendicitis without knowing that the person recently had an appy done. Fail much?

That's utterly unforgivable. A more amusing situation is when someone has had a Ladd's procedure done, and the ER consults surgery for appendicitis.

 

[2012mdc]

That's utterly unforgivable. A more amusing situation is when someone has had a Ladd's procedure done, and the ER consults surgery for appendicitis.

hahaha

You could always scrub in a few cases, then go see clinic patients, do hospital consults, and do post-op checks. For anyone not going into surgery, seeing surgery clinic and doing surgical consults will still be useful. Our students always tend to load up their days with cases and do little else, but that's certainly not because tell them that's what they should do. Most of our attendings have at least 2 days of clinic and are more than happy to have students/residents work with them.

Having students do a fair amount of a procedure is an expensive OR endeavor. The cost of OR time that I've heard quoted is $60/minute. Why bother letting someone close skin if they have no interest in a surgical specialty or even a specialty where they would have to suture at all? It'll cost an extra $300, every single time.

As much as I dislike rounding and clinic it was a necessary learning experience. On my rotation we had 2.5 days of OR time and the remainder was clinic, doing consults, taking care of our own patients on the floor, and lecture.

I did not get to do much in the OR but I still learned a lot on the rotation. My only regret is not being better at suturing after the rotation but that is also something that I can (and have) practice on my own time

 

[Perrotfish]

Having students do a fair amount of a procedure is an expensive OR endeavor. The cost of OR time that I've heard quoted is $60/minute. Why bother letting someone close skin if they have no interest in a surgical specialty or even a specialty where they would have to suture at all? It'll cost an extra $300, every single time.

I think those are all good points and I don't think medical students should be doing more in the OR. You're right, its expensive and its also pointless because if they don't go into surgery they'll never use those skills again. However I wasn't arguing that students should do more n the OR. I was arguing that there's no role for medical students in a modern surgery rotation and that the rotation is an anachronism that should be eliminated from the cirriculum.

Modern medical education was designed for an age when 90% of physicians went straight into general practice from Intern year, most of them practiced in rural enverionements, and there was no way to evacuate people to secondary or tertiary care centers. That's why Surgery and OB rotations are mandatory, long rotations: a mere year out of medical school a newly minted doctor could be doing open abdominal surgery, orthopaedic surgery including amputations, and deliving all kinds of babies. So they needed lots of practice. Now, though, what's the point? Surgery is a terrible learning enviornment that teaches a skillset that is not particularly useful for non surgeons. At best it's an inefficient way to learn what you could learn more efficiently on Medicine, and at worst it's a never ending parade of gallbladder surgeries that add nothing of value to your education. Surgery (and OB) should be electives for students who plan have a career in the OR.

 

[2012mdc]

I think those are all good points and I don't think medical students should be doing more in the OR. You're right, its expensive and its also pointless because if they don't go into surgery they'll never use those skills again. However I wasn't arguing that students should do more n the OR. I was arguing that there's no role for medical students in a modern surgery rotation and that the rotation is an anachronism that should be eliminated from the cirriculum.

Modern medical education was designed for an age when 90% of physicians went straight into general practice from Intern year, most of them practiced in rural enverionements, and there was no way to evacuate people to secondary or tertiary care centers. That's why Surgery and OB rotations are mandatory, long rotations: a mere year out of medical school a newly minted doctor could be doing open abdominal surgery, orthopaedic surgery including amputations, and deliving all kinds of babies. So they needed lots of practice. Now, though, what's the point? Surgery is a terrible learning enviornment that teaches a skillset that is not particularly useful for non surgeons. At best it's an inefficient way to learn what you could learn more efficiently on Medicine, and at worst it's a never ending parade of gallbladder surgeries that add nothing of value to your education. Surgery (and OB) should be electives for students who plan have a career in the OR.

Be careful about generalizing your experiences to mean the system is broken. You do make some good points though.

Surgery and OB are necessary rotations, they should just be streamlined and more efficient. I believe the ability to handle a uncomplicated SVD is a skill all physicians should have. Also all physicians should be able to recognize common surgical emergencies

 

[drizzt3117]

That's utterly unforgivable. A more amusing situation is when someone has had a Ladd's procedure done, and the ER consults surgery for appendicitis.

I saw a r/o appendicitis in a Chiari pt s/p Mitrofanoff...

 

[Perrotfish]

I believe the ability to handle a uncomplicated SVD is a skill all physicians should have.

Why?

 

[45408]

I think those are all good points and I don't think medical students should be doing more in the OR. You're right, its expensive and its also pointless because if they don't go into surgery they'll never use those skills again. However I wasn't arguing that students should do more n the OR. I was arguing that there's no role for medical students in a modern surgery rotation and that the rotation is an anachronism that should be eliminated from the cirriculum.


Surgery is a terrible learning enviornment that teaches a skillset that is not particularly useful for non surgeons. At best it's an inefficient way to learn what you could learn more efficiently on Medicine, and at worst it's a never ending parade of gallbladder surgeries that add nothing of value to your education.

It's not what you could be learning on medicine. Internists and hospitalists are not the right people to be teaching you about surgical pathology, but believe me, they (and you) still need to know about it. Internists medically manage things that can and do turn into surgical issues all the time - GERD, cholelithiasis, PUD, diverticulitis, mammographic and palpable breast abnormalities, blah blah blah.

An internist should be able to recognize things like hemorrhoids and anal fissures, because the patient is going to come to them with those complaints. You'll get a lot of exposure to those things in surgery clinic.

Just a brief example is that we had a lady come in with a diagnosis of recurrent diverticulitis. The usual course of treatment is a sigmoid resection. The problem? No one had properly diagnosed her the first two times (never been scoped, never had a CT, never seen by a surgeon). It was just a presumed diagnosis, and now we had a CT that showed diverticulitis. So is this a recurrence or the first episode? So does she need surgery or not?

 

[badasshairday]

Why?

Because you are a physician.

 

[Bacchus]

I just failed OB/GYN. I had to google "SVD medicine" to figure out what this meant.

 

[ArcGurren]

That's utterly unforgivable. A more amusing situation is when someone has had a Ladd's procedure done, and the ER consults surgery for appendicitis.

LMFAO oh god.

 

[SLUser11]

Just a brief example is that we had a lady come in with a diagnosis of recurrent diverticulitis. The usual course of treatment is a sigmoid resection. The problem? No one had properly diagnosed her the first two times (never been scoped, never had a CT, never seen by a surgeon). It was just a presumed diagnosis, and now we had a CT that showed diverticulitis. So is this a recurrence or the first episode? So does she need surgery or not?

While I agree that the episodes of diverticulitis should have been documented with a CT scan, does it really matter how many episodes have occurred?

Is sigmoid resection really the treatment for recurrent diverticulitis? If so, how many episodes? Does it matter how old the patient is? Does it matter if they required IV antibiotics? What about if they got an abscess?

I guess my point is that if you are wondering whether or not a patient needs a sigmoidectomy based on 2 vs. 3 uncomplicated attacks, the answer is no, she does not need a sigmoidectomy.

This is actually a pretty interesting topic, but I think we should discuss it in the surgery forums for higher yield.

 

[Jolie South]

It's not what you could be learning on medicine. Internists and hospitalists are not the right people to be teaching you about surgical pathology, but believe me, they (and you) still need to know about it. Internists medically manage things that can and do turn into surgical issues all the time - GERD, cholelithiasis, PUD, diverticulitis, mammographic and palpable breast abnormalities, blah blah blah.

An internist should be able to recognize things like hemorrhoids and anal fissures, because the patient is going to come to them with those complaints. You'll get a lot of exposure to those things in surgery clinic.

Just a brief example is that we had a lady come in with a diagnosis of recurrent diverticulitis. The usual course of treatment is a sigmoid resection. The problem? No one had properly diagnosed her the first two times (never been scoped, never had a CT, never seen by a surgeon). It was just a presumed diagnosis, and now we had a CT that showed diverticulitis. So is this a recurrence or the first episode? So does she need surgery or not?

If my medicine rotation was any indicator of how good internists are at management of surgical conditions, yea, they're just not good. I think it would be highly inappropriate to learn management from them.

I have to disagree with removing the surgical rotation from the curriculum. I had a really good experience where I had attendings and residents that taught and at the same time didn't keep us for ungodly hours. We didn't take call, only rounded on patients on the weekends.

A crappy surgery rotation is just not "par for the course."

 

[2012mdc]

Because you are a physician.

Exactly.

It's just my opinion but I just think it's something that a physician should know how to do

 

[smq123]

At best it's an inefficient way to learn what you could learn more efficiently on Medicine, and at worst it's a never ending parade of gallbladder surgeries that add nothing of value to your education. Surgery (and OB) should be electives for students who plan have a career in the OR.

I don't know how your rotations were set up, but the things that I learned on surgery were in no way, shape, or form, things that I could have learned on medicine.

You don't learn to suture on medicine. You don't learn how to properly evaluate hernias on medicine. I saw ONE acute abdomen on medicine, as opposed to the half-dozen I saw on surgery. I never learned how to manage SBOs on medicine, either. I learned about breast cancer on OB and surgery - the medicine residents I saw barely knew how to properly do a breast exam. The list goes on and on.

As an FM resident, I use what I learned on my surgery rotationS (I had to do them as an FM resident, too) every week in clinic. Hernias, rectal bleeding, hemorrhoids, possible breast cancer, I&Ds, suturing up lacerations, wound care - all stuff I learned on surgery; these were topics that were never brought up on my medicine rotation.

Plus, at least you get to see on surgery what truly is and isn't an emergency. Medicine residents are terrible at figuring out what can be done as an outpatient and what can't, which leads to such moves such as consulting trauma surgery for a stat breast biopsy (which my resident made me call in ).

As for OB....if I have to hear one more IM trained person tell me that it's "probably HELLP" for every pregnant patient, even those who are only in their 2nd trimester.... (Hint: HELLP is seen before the 3rd trimester in case studies. It's very rare to see it that early in pregnancy.)

Finally, by your logic, it's a waste of time for people going into pathology to do ANY clinical rotations. After all, they're never going to do it again, so why make them? Why make future pediatricians do adult IM rotations, when everything they need to know about general medicine they could learn just as well on the peds floors? Why make future anesthesia residents do a psych rotation? etc.

 

[SLUser11]

LMFAO oh god.

Why?

Is it really that unforgiveable? You guys are laughing because you just recently learned that a Ladd's procedure includes an appendectomy, but do you think you'll remember this when you are an ER attending? Do you think ER attendings even know what a Ladd's procedure is?

Can we really clown on ER docs for not knowing the intricacies of a rare pediatric surgical procedure? And, how often does the patient know exactly what they had done? Did the mom come in saying "my son had a Ladd's procedure, and his appendix is gone."

Another question: What else causes RLQ pain in kiddos? It's a short list, with appendicitis being #1 by far. While I'm not endorsing the ER doc's behavior, I think it's a more forgiveable miss than a lot of the other things they do.

And is it really a med student's place to clown on an ER doc for not knowing what a Mitrofanoff is? 95% of the people reading this sentence don't know what it is.

 

[Jolie South]

Exactly.

It's just my opinion but I just think it's something that a physician should know how to do

Agreed. Say what you will about Ob/Gyn, that's just one of those things.

 

[ArcGurren]

Why?

Is it really that unforgiveable? You guys are laughing because you just recently learned that a Ladd's procedure includes an appendectomy, but do you think you'll remember this when you are an ER attending? Do you think ER attendings even know what a Ladd's procedure is?

Can we really clown on ER docs for not knowing the intricacies of a rare pediatric surgical procedure? And, how often does the patient know exactly what they had done? Did the mom come in saying "my son had a Ladd's procedure, and his appendix is gone."

Another question: What else causes RLQ pain in kiddos? It's a short list, with appendicitis being #1 by far. While I'm not endorsing the ER doc's behavior, I think it's a more forgiveable miss than a lot of the other things they do.

And is it really a med student's place to clown on an ER doc for not knowing what a Mitrofanoff is? 95% of the people reading this sentence don't know what it is.

I'm pretty sure I can fault a number of ER docs for shuffling off all their patients with surgical "RLQ pain r/o appendicitis" consults without even looking at the charts to see if they had an appy done. Also generally speaking if you see a Ladd's procedure... you should be able to look it up if you don't know what it is. Not reading a patient's chart is the height of laziness.

And I haven't a clue what a Mitrofanoff is, but that's besides the point.

 

[drizzt3117]

Why?

Is it really that unforgiveable? You guys are laughing because you just recently learned that a Ladd's procedure includes an appendectomy, but do you think you'll remember this when you are an ER attending? Do you think ER attendings even know what a Ladd's procedure is?

Can we really clown on ER docs for not knowing the intricacies of a rare pediatric surgical procedure? And, how often does the patient know exactly what they had done? Did the mom come in saying "my son had a Ladd's procedure, and his appendix is gone."

Another question: What else causes RLQ pain in kiddos? It's a short list, with appendicitis being #1 by far. While I'm not endorsing the ER doc's behavior, I think it's a more forgiveable miss than a lot of the other things they do.

And is it really a med student's place to clown on an ER doc for not knowing what a Mitrofanoff is? 95% of the people reading this sentence don't know what it is.

As a future radiologist, I can't really complain about imaging studies being ordered, but is it asking that much to look at the pt's surgical history? I don't expect most people to know what a Mitrofanoff is (I do bc I did a urology rotation) but it's obv this kid had had a lot of prior surgery. I suppose in this case a "uti" would actually be appendicitis, if taken completely literally.

 

[drizzt3117]

I'm pretty sure I can fault a number of ER docs for shuffling off all their patients with surgical "RLQ pain r/o appendicitis" consults without even looking at the charts to see if they had an appy done. Also generally speaking if you see a Ladd's procedure... you should be able to look it up if you don't know what it is. Not reading a patient's chart is the height of laziness.

And I haven't a clue what a Mitrofanoff is, but that's besides the point.

For the record, a Mitrofanoff is a procedure where a surgeon (typically a urologist) separates the appendix from the cecum while maintaining it's blood supply and uses it as a conduit between the bladder and the skin surface (usually through the umbilicus) so they can self catheritize urine. It's commonly done when pts are paraplegic from conditions like spina bifida so the pt can more easily catheritize themselves.

 

[45408]

While I agree that the episodes of diverticulitis should have been documented with a CT scan, does it really matter how many episodes have occurred?

Is sigmoid resection really the treatment for recurrent diverticulitis? If so, how many episodes? Does it matter how old the patient is? Does it matter if they required IV antibiotics? What about if they got an abscess?

I guess my point is that if you are wondering whether or not a patient needs a sigmoidectomy based on 2 vs. 3 uncomplicated attacks, the answer is no, she does not need a sigmoidectomy.

This is actually a pretty interesting topic, but I think we should discuss it in the surgery forums for higher yield.

Dammit, all I was trying to say is that internists do manage surgical issues in some way

Why?

Is it really that unforgiveable? You guys are laughing because you just recently learned that a Ladd's procedure includes an appendectomy, but do you think you'll remember this when you are an ER attending? Do you think ER attendings even know what a Ladd's procedure is?

Can we really clown on ER docs for not knowing the intricacies of a rare pediatric surgical procedure? And, how often does the patient know exactly what they had done? Did the mom come in saying "my son had a Ladd's procedure, and his appendix is gone."

Another question: What else causes RLQ pain in kiddos? It's a short list, with appendicitis being #1 by far. While I'm not endorsing the ER doc's behavior, I think it's a more forgiveable miss than a lot of the other things they do.

And is it really a med student's place to clown on an ER doc for not knowing what a Mitrofanoff is? 95% of the people reading this sentence don't know what it is.

Well, I definitely had to Google Mitrofanoff, but I would also hope someone reviewing the past surgical history might google that as well, or a Ladd's.


And the other RLQ pain in kids that I've seen before was mesenteric adenitis, but that's about it.