The stigma of being a third year

[ssg]

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I'm currently in my second week of my surgery rotation and at this point I am F#%*&@! hating it. I'm the only third year here. The rest of the students are all 4th years. The residents seem to prefer working with the fourth years cause they already know surgery and don't need to be taught much. Half the time I seem to be ignored even though I get in their face and ask them if I could help. Every time they ask me to present a topic for the next day, for some reason the chief forgets what he told me to present on and tell me to present on something totally different that I haven't even prepared for. They give me one patient to follow most times. In the OR I get last dibs to scrubbing in cause the 4th years and interns want to. Even if I scrub in, I don't really get to do much. So far, no ones taught me surgical ties or suturing. I don't know this may sound like I'm just ranting and complaining but I don't know what to do. How do I make the most out of this rotation? Has anyone had similar experiences in their surgery rotation? Don't get me wrong, I don't hate surgery, I would love to scrub in on every case and handle a few more patients then they give me. I think I would learn a lot more that way. But I don't get how I am gonna be able to do that.

 

[Blade28]

I think you're doing the right thing by talking to your residents, asking them to present, take on more patients, scrub, etc. It's going to be natural that they feel more comfortable with the MS-IVs - usually they want to go into surgery, or they're sub-Is, etc. But show your interest and enthusiasm, and try not to get too down - you're doing the best you can.

 

[Top Gun]

I'm currently in my second week of my surgery rotation and at this point I am F#%*&@! hating it. I'm the only third year here. The rest of the students are all 4th years. The residents seem to prefer working with the fourth years cause they already know surgery and don't need to be taught much. Half the time I seem to be ignored even though I get in their face and ask them if I could help. Every time they ask me to present a topic for the next day, for some reason the chief forgets what he told me to present on and tell me to present on something totally different that I haven't even prepared for. They give me one patient to follow most times. In the OR I get last dibs to scrubbing in cause the 4th years and interns want to. Even if I scrub in, I don't really get to do much. So far, no ones taught me surgical ties or suturing. I don't know this may sound like I'm just ranting and complaining but I don't know what to do. How do I make the most out of this rotation? Has anyone had similar experiences in their surgery rotation? Don't get me wrong, I don't hate surgery, I would love to scrub in on every case and handle a few more patients then they give me. I think I would learn a lot more that way. But I don't get how I am gonna be able to do that.

As a third year, your residents don't expect as much from you as they would a fourth year. This is why you only follow one patient at a time. Sometimes, though, this can be a good thing. You have the chance to really get to know what is going on with your patient. If you can show that you are really on top of things with this patient, you will look like a star, and the residents will gradually give you more responsibility. Also, keep showing interest. If you can do that, you might find that your residents will allow you to do more procedures. Of course, be careful that you don't look like a tool when you show interest (i.e. saying something like, "Oh wow, a foley, that's sooooo cool!"). But if you can do something like answer whatever pimp questions the residents ask you, that will show the residents that you've been reading, and that you're interested.

 

[Winged Scapula]

While I am sorry you are having a bad time on the rotation, perhaps an explanation of the mind set would help:

- especially early in the 3rd year when you are relatively new to the wards, many Chief and senior residents prefer the students to only have 1 patient. That way you can focus on getting to know them really well, rather than simply being a collector of vital signs and being spread too thin. I would certainly listen to a student who asked for more patients, but it may be that your Chief wants you to focus on one.

- teaching suturing and tying knots are generally not formalized; that is, if your program doesn't have a seminar on how to do it (which generally isn't thorough enough) you are often expected to practice outside of the OR. If you need help getting started, ask one of the students or residents to help you. This is a common activity on call if the night is slow.

- actually doing suturing in the OR is often seen as a "reward" for surviving the rotation. I know attendings who don't let the students suture until the final few days of the rotation.

- suturing in the OR may also be dependent on time factors (if they are not running behind), patient factors, and whether or not the attending feels comfortable scrubbing out and letting the resident take you through it

This time of the year is a hard time for the 3rd years because you are being pushed aside by the 4th years doing Sub-Is and the interns who are eager to get into the OR. Some services frankly have too many students and residents for everyone to get to do something in the OR, especially if you are on the PD's or Chairman's service. But try and ask for some teaching and to find something valuable in each day.

 

[Llenroc]

Most folks in Surgery are the nastiest people you've ever met. Don't let it color your expectations of the rest of medicine.

Oh yeah, consider yourself lucky that you don't have enough patients to follow and you still look forward to going to the OR. On rotations that I've been on, they'll easily make you write 10-20 notes a day. And there might be more operations happening than students on the service, in which case after rounds you scrub cases non-stop until 7 or 8 at night, without lunch, dinner, a bathroom break, or so much as a drop of water "BECAUSE EVERY CASE MUST HAVE A MEDICAL STUDENT IN IT!!!"

 

[michelleDO]

Hey,

All I have to say is Me Too!!! Same thing is happening to me. I am also in Surgery (3rd week). I am also the only third year here, and no one even looks at me when they are having conversations with each other and I am right infront of them - I am ignored totally. The fourth years and interns are all buddy buddy. The fourth years are offered to learn and do central lines, etc even when I have been there longer then they have. Once, I even prepared for the line and collected all the equipments for the resident and I was all excited because I thought the resident will offer me, then a fourth year came into the room and the resident automatically offered the fourth year to try. I just stood there trying to stop the tears. And that fourth year had done many with the same resident and interns. No one talks to me ever when I am right next to them. About suturing, I already told the resident many times that I have done it once, but I never got offered and instead the fourth year was given priority. It sucks. But, I made friends with one nurse who ended up giving me a suture kit. When someone talks to me lets say a fourth year trying to pimp me, I acted as if I was soo glad to get the attention, and still say thank you after being pimped. I just think that its almost over and that it will pass and become history. Good luck

 

[MrBurns10]

Believe me, you two aren't alone...I'd say the vast majority of med students feel ignored on surgery. I was just talking today with a classmate of mine about how if you do something wrong, even minor, you'll get yelled at or demeaned. But if you do something right, you get ignored. It's almost like the goal is TO BE ignored because you're not getting yelled at. Just remember that not all surgeons/people are like that and that you should appreciate the experience because it'll be over before you know it.

Of course, I need to take my own advice because I'm 2 weeks away from being done with surgery and I'm already tearing my eyes out. I've gotten yelled at for talking to the anesthesiologist during a surgery I wasn't even scrubbed in on, I've gotten "Med students should only speak when spoken to," etc. There is no rhyme or reason for why some people are the way they are, and you just have to not take it personally and do the best you can. That's all you can ask of yourself. good luck 🙂

 

[jdh71]

Heh . . .

Maybe it's the time of year, I took G-surg in March, but I was up to my a-hole in alligators - all I wanted was a chance to breathe. I was seeing 4-5 patients every morning, seeing at least one consult a day, presenting on rounds, presenting for tumor board, scrubbing into any case available, and when not doing any of that, seeing patients in clinic . . .

The sword cuts both ways . . . all that exposure sure lead to a lot more criticism. Too bad really . . . ruined my opinion of surgery, but in the end even though I really, really liked the medicine or surgery, acute issues (especially trauma), being in the OR, etc. at the end of the day, I'm NOT a surgeon and that's an important distinction for one to make.

 

[ssg]

Thank you all for the support. You are all right. I just have to take a deep breathe at the end of the day, wake up at 4 the next morning and start all over again. I guess this is all part of the game. I just wish I was learning more...

 

[Blade28]

Most folks in Surgery are the nastiest people you've ever met. Don't let it color your expectations of the rest of medicine.

Oh yeah, consider yourself lucky that you don't have enough patients to follow and you still look forward to going to the OR. On rotations that I've been on, they'll easily make you write 10-20 notes a day. And there might be more operations happening than students on the service, in which case after rounds you scrub cases non-stop until 7 or 8 at night, without lunch, dinner, a bathroom break, or so much as a drop of water "BECAUSE EVERY CASE MUST HAVE A MEDICAL STUDENT IN IT!!!"

Welcome to life as a resident. 🙁

 

[PeeWee137]

try and make friends with the 4th years. if the residents are too busy you can follow them around instead. i think its a win win, if the 4th year helps you out, it makes the resident's life easier, and in turn will help the 4th year shine on their sub-i for taking initiative. i spent 3 weeks on medicine with a 4th year who helped me do h+p's and write notes, i really learned alot and boy did she get a great eval.
and if you have time, DEFINITELY make friends with the scrub nurses. ask them to show you what all the surgical instruments are called, etc. they probably know how to suture too. once i got on their good side, they would stuff my pockets full of sutures and clamps so i could practice my knots.
you can never underestimate being nice.

 

[elwademd]

speaking as someone who went into internal medicine...

if you want to go into general surgery or any of the surgical specialities, then do what you have to do in order to shine and get experience.

if you want to go into anything other than surgery, count your rotation as you've experienced it so far as a blessing!

there will be other opportunities to suture and see patients in your final 2 years of medical school.

 

[Samoa]

It's likely that the residents think they are doing you a favor by only asking you to see one or two patients. It's hard to learn effectively about each patient's disease and typical hospital course if you have more than one or two of them at this time of year. And perhaps your interns feel like none of their patients would be a good learning experience for you. As an example, we call one corner of our ward "the hallway of doom" and would NEVER ask our students to follow any of them.

But if you feel like you can handle more, by all means ask for more. Or just say, as one of our med students did this past week, "I'm going to write notes and present w,x,y and z tomorrow if that's OK with you."

Major bonus points for that student. And as long as no other student is writing notes for those patients, it should be fine.

Regarding the OR, it does suck when there are too many people in on a case. A lot of it depends on how gung ho your upper levels are to operate. On my service right now, it seems like the attending, chief and R3 are in on every case, whereas last month there were a number of cases where it was just me (the R1) and a med student, and an upper level OR the attending but never both. The med student got to do a substantial portion of those cases.

I sympathize with your situation--my own surgery rotation sucked donkey balls. But if you're interested in being more involved, let your residents know. Or as things come up that you want to do, ask to do them.

 

[psychbender]

This is why I'm glad my surgery rotation is as a hospital without residents...just me and two very cool attendings for a month.

 

[AmoryBlaine]

People have already mentioned this but judging from the time of year it is the M4s are probably going into surgery. I am not surprised that they are getting considerably more love than you.

Third year of medical school is probably the hardest year of your training. I have talked to numerous residents/attendings who say that the one year they would not repeat is M3.

It does get better when you're an M4. Try not to be so hard on the M4s, even for "stealing" central lines. G-surg is actually pretty competitive, esp at the good programs so I'm sure they are trying to shine. In the world of less malignant specialties, for an M4 to defer to you for a crack at a line would probably be looked upon as a cool move but in surgery the residents would probably say "wtf?"

Also, and this was something that took me awhile to learn, you're not rotating through surgery to learn how to do surgery. Any suturing etc. is bonus.

 

[Blade28]

Third year of medical school is probably the hardest year of your training. I have talked to numerous residents/attendings who say that the one year they would not repeat is M3.

The hardest year in med school, or the hardest year through all of your training before you're an attending?

Because yeah, in med school, your MS-III year is the roughest.

But compared to a busy internship? Can't even hold a candle.

 

[Winged Scapula]

If you thought you felt dumb during MS-3, wait until internship when everyone is ready to affirm your fears!

 

[ssg]

I don't know... being the ONLY third year here, I can't seem to gauge my performance as compared to others. I don't know if I'm doing really bad or is it that I'm just being a regular third year. Today for some reason while I was scrubbed in with the chief and a snotty attending, the chief tells him that I'm not considering surgery and the attending says thats really good. wtf??? The attending doesn't even know me, that was the second time i scrubbed in on his case. And by the way I never told anyone that I wasn't considering surgery. I feel that because they are so busy ignoring me, they won't be able to evaluate me at the end. Do people fail their surgery core?

 

[Ypo.]

Today for some reason while I was scrubbed in with the chief and a snotty attending, the chief tells him that I'm not considering surgery and the attending says thats really good.

Maybe he thinks surgery is a rotten field to go into?

 

[Top Gun]

I don't know... being the ONLY third year here, I can't seem to gauge my performance as compared to others. I don't know if I'm doing really bad or is it that I'm just being a regular third year. Today for some reason while I was scrubbed in with the chief and a snotty attending, the chief tells him that I'm not considering surgery and the attending says thats really good. wtf??? The attending doesn't even know me, that was the second time i scrubbed in on his case. And by the way I never told anyone that I wasn't considering surgery. I feel that because they are so busy ignoring me, they won't be able to evaluate me at the end. Do people fail their surgery core?

WTF??? It sounded like you were showing considerable interest. You're just getting overshadowed by the fourth years. Why would the chief and attending automatically assume you were going into something else?

 

[AmoryBlaine]

The hardest year in med school, or the hardest year through all of your training before you're an attending?

Because yeah, in med school, your MS-III year is the roughest.

But compared to a busy internship? Can't even hold a candle.

I probably should have been more clear, my colleagues describe M3 as the year they would least like to repeat, not necessarily the most demanding. I meant hardest in terms of personal strain rather than sheer volume of work.

 

[Blade28]

I probably should have been more clear, my colleagues describe M3 as the year they would least like to repeat, not necessarily the most demanding. I meant hardest in terms of personal strain rather than sheer volume of work.

I'd rather repeat my MS-III year than my intern year.

 

[AmoryBlaine]

I'd rather repeat my MS-III year than my intern year.

Yeah, but you're a surgeon right? That's by far the hardest PGY1. Bottom line is I'm right. 😀

 

[Blade28]

Yeah, but you're a surgeon right? That's by far the hardest PGY1. Bottom line is I'm right. 😀

In two years' time, after you've finished your intern year in whatever field you decide on, let me know how brutal it was. 🙂 It's usually rough for most people, except maybe transitionals.

But yes, I agree, surgery internship is particularly rough.