Things I Hate About Third Year

[da8s0859q]

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I cant wait...

Surgery is love or hate. You might love it.

@Def: what makes residency so amazing?

 

[MilkmanAl]

I dunno about that. I liked surgery (i.e., surgery itself), but thanks to the hours and teaching styles, didn't care that much for the rotation as a whole. I waver as to whether I had more positive or negative feelings towards the rotation, so I certainly wouldn't say I either loved or hated it. The only rotation I've encountered that has been truly that polarizing was OB/Gyn. The only people I know who liked it either liked it for the surgical aspect (and are going to be surgeons) or are doing OB. Everyone else hated it.

 

[liberaldoc238]

lol it's probably just the people you hang around. Most of the people I talk to, despite the field they are going into, do not talk about stuff they have seen (and if they do it bugs the crap out of me unless it is interesting).

you just need to find a field you care somewhat about. Or at least pick a field with predictable schedule and somewhat routine work.

To me it seems anesthesia may fit you well. Work is fairly routine. Mostly fixed schedules with shift work. Interact with lots of different types of people besides doctors. Don't have to deal with tons of different disease (yes you'll see a lot but the role of anesthesia is limited to a specific job). If you are in a long procedure you can basically sit and play on your phone or read a book if nothing's happening that needs your attention.

The thing that bothers me the most about medicine is the fact that you work ridiculous hours for years during the training period. This is also a period that happens to be the "prime" years of your life. Im fine with working a job that I can stand for 40 hours a week....at least I have the evenings and my weekends.........not so in medicine. There is still the mentality in medicine that it should be your "life"....I think this is changing but not there yet. All the old farts have to retire. I feel sorry for the people who desire to be a damned "textbook". I can look up things on uptodate in thirty seconds.

 

[da8s0859q]

I dunno about that. I liked surgery (i.e., surgery itself), but thanks to the hours and teaching styles, didn't care that much for the rotation as a whole. I waver as to whether I had more positive or negative feelings towards the rotation, so I certainly wouldn't say I either loved or hated it. The only rotation I've encountered that has been truly that polarizing was OB/Gyn. The only people I know who liked it either liked it for the surgical aspect (and are going to be surgeons) or are doing OB. Everyone else hated it.

Hm, interesting. For us, quite a few kind of like the OR time with staff/residents who actually let you do things, but resent 95% of the rotation overall and are dead-set against ever applying to a surgical residency. I think I've talked to maybe two people who are lukewarm about the whole thing, but they tend to be like that about lots of things.

 

[FSU2013]

The thing that bothers me the most about medicine is the fact that you work ridiculous hours for years during the training period. This is also a period that happens to be the "prime" years of your life. Im fine with working a job that I can stand for 40 hours a week....at least I have the evenings and my weekends.........not so in medicine. There is still the mentality in medicine that it should be your "life"....I think this is changing but not there yet. All the old farts have to retire. I feel sorry for the people who desire to be a damned "textbook". I can look up things on uptodate in thirty seconds.

Sure, you can look stuff up quickly, but that assumes you know what to look up. You're a little further down the road in medicine than I am, but it seems like there's a lot of merit in knowing medicine inside out. If you end up seeing a super rare zebra, you might miss it for a horse if you aren't a "textbook" because you simply don't know what you don't know. I don't think medicine should be all you have in life, but simply due to the nature of medicine it seems like working 40 hours a week would leave you ill prepared. Also, compensation would have to go trough the roof.

 

[xanthomondo]

Sure, you can look stuff up quickly, but that assumes you know what to look up. You're a little further down the road in medicine than I am, but it seems like there's a lot of merit in knowing medicine inside out. If you end up seeing a super rare zebra, you might miss it for a horse if you aren't a "textbook" because you simply don't know what you don't know. I don't think medicine should be all you have in life, but simply due to the nature of medicine it seems like working 40 hours a week would leave you ill prepared. Also, compensation would have to go trough the roof.

It's not the number of hours that bothers me, I have no problem putting hard work into whatever I'm doing. It is how inefficient those hours are in serving any educational purpose. There's so much time wasted standing around in the OR, standing around watching attendings write notes, waiting for patients on consults, etc. Just because it's not 5 or 6 pm doesn't mean I shouldn't be able to go home if there's nothing else going on for the day.

 

[da8s0859q]

It's not the number of hours that bothers me, I have no problem putting hard work into whatever I'm doing. It is how inefficient those hours are in serving any educational purpose. There's so much time wasted standing around in the OR, standing around watching attendings write notes, waiting for patients on consults, etc. Just because it's not 5 or 6 pm doesn't mean I shouldn't be able to go home if there's nothing else going on for the day.

Agree 100%.

Also with the "medicine isn't life" sentiment. I have classmates who are the type who will marry their work, and the world needs that in "hard" professions, but I just can't do it. We are not meant to eat/work/breathe an occupation.

 

[tco]

The thing that bothers me the most about medicine is the fact that you work ridiculous hours for years during the training period. This is also a period that happens to be the "prime" years of your life. Im fine with working a job that I can stand for 40 hours a week....at least I have the evenings and my weekends.........not so in medicine. There is still the mentality in medicine that it should be your "life"....I think this is changing but not there yet. All the old farts have to retire. I feel sorry for the people who desire to be a damned "textbook". I can look up things on uptodate in thirty seconds.

You won't see what's not in your head.

 

[MajinVegeta]

yous a sk@

 

[olemissbabydoc]

Surgery is love or hate. You might love it.

@Def: what makes residency so amazing?

Love all the surgery hate around here. I got the two worst rotations possible, starting Monday. 56 days. UGH.

 

[da8s0859q]

Love all the surgery hate around here. I got the two worst rotations possible, starting Monday. 56 days. UGH.

Ouch. My school's surgery rotation is 12 weeks, spanning across the VA and our trauma service and various other services. I feel your pain -- hang in there! You might even like it more than you think you will.

 

[VenusinFurs]

24 hour calls.

The thing I hate most about third year, though, is myself.

 

[olemissbabydoc]

24+ hr calls. Generally about 30 hrs. Last time I checked I'm not an upper level resident!!!

 

[da8s0859q]

24+ hr calls. Generally about 30 hrs. Last time I checked I'm not an upper level resident!!!

Panda Bear's old posts about the different M3 rotations always said the same thing about med student call: all in all, it's useless. I'm inclined to agree.

 

[Skinceutical]

3) Residents or Attendings who have me pick up a patient.... after they have already seen them, examined them, and ordered everything. Nothing says "I'm a little poser" like walking into a room and saying to that patient, "Hi ma'am, I'm the medical student working with Dr. X. Tell me about what's going on today". Patient: "Uh, I already saw the doctor". Me: "Yeah.... he wants me to play doctor with you, see my cool short white coat!

I hated that as an MS3 as well.

Then when I was an intern, I realized that there's actually a good reason for it. As an intern, I could see a patient, put in admission orders, and write my H&P in a fraction of the time it took the med students to interview & examine someone. I don't think its appropriate for patients to be sitting on the floor with no orders for 90 minutes because the MS3 is still busy getting an excruciatingly detailed history before any residents come in. Nor was it an effective use of my time, when I had multiple admissions and cross cover to take care of.

 

[xanthomondo]

24+ hr calls. Generally about 30 hrs. Last time I checked I'm not an upper level resident!!!

Panda Bear's old posts about the different M3 rotations always said the same thing about med student call: all in all, it's useless. I'm inclined to agree.

I agree as well. 24+ hr call as a third year medical student has nothing to do with education or helping the team, it just serves to make sure you know that you're a powerless nothing and they own you for the entire rotation no matter what.

 

[45408]

Panda Bear's old posts about the different M3 rotations always said the same thing about med student call: all in all, it's useless. I'm inclined to agree.

Disagree. I only had overnight call on OB and trauma surgery as an M3, and those rotations definitely had a lot happening every night.

 

[da8s0859q]

Disagree. I only had overnight call on OB and trauma surgery as an M3, and those rotations definitely had a lot happening every night.

Different sort of rotation, I guess. I had overnight call on trauma surgery also, and it basically amounted to doing the monkey sheets on traumas for our then less-than-friendly seniors and not a whole lot else. Sometimes saw a few consults, had a few emergent cases go to the OR, but just as often got sent to sleep by my off-service interns at some point.

I think there's some utility in pushing med students to the point of pulling those kinds of hours a few times, but beyond that, nothing I learned on those nights required a 24-30 hour stay.

 

[2012mdc]

Disagree. I only had overnight call on OB and trauma surgery as an M3, and those rotations definitely had a lot happening every night.

At a county hospital the more exciting trauma cases definitely happened at night.

On OB we didn't have overnight call. There was a day shift and a night shift so you were never there more than 14 hrs. I couldn't imagine having to do 30 straight hours of OB 😱

 

[umz]

Agree with TheProwler. Loved trauma call. Learned a lot and got a lot of experience doing procedures and participating in resuscitations. More hours = more experience.

Didn't have to do 24 hr call on any other rotation.

 

[olemissbabydoc]

I like trauma call. I just know I'm not learning anything at 24 hours out (and think it's rediculous that they keep us longer than the interns just because they can). Surgery is the only rotation brave enough to still do it. Other than this one, we work intern hours.

 

[45408]

Different sort of rotation, I guess. I had overnight call on trauma surgery also, and it basically amounted to doing the monkey sheets on traumas for our then less-than-friendly seniors and not a whole lot else. Sometimes saw a few consults, had a few emergent cases go to the OR, but just as often got sent to sleep by my off-service interns at some point.

I think there's some utility in pushing med students to the point of pulling those kinds of hours a few times, but beyond that, nothing I learned on those nights required a 24-30 hour stay.

We did get a fair amount of penetrating trauma and such well into the night, so yes, the experience will vary by location.

At a county hospital the more exciting trauma cases definitely happened at night.

On OB we didn't have overnight call. There was a day shift and a night shift so you were never there more than 14 hrs. I couldn't imagine having to do 30 straight hours of OB 😱

My OB call was 25 hours - we'd come in at 6am and leave after 7am sign out the following day.

I like trauma call. I just know I'm not learning anything at 24 hours out (and think it's rediculous that they keep us longer than the interns just because they can). Surgery is the only rotation brave enough to still do it. Other than this one, we work intern hours.

Newsflash: you won't be working "intern hours" for most of your residency, and if you want to have any idea how you'll handle the majority of your residency, med school is the only way you'll find out.

The worst thing that could have happened is that I was fooled into thinking that surgery was fun and happy because I was only there from 6a-6p every day, only to become a resident and realize that the call schedule was far worse than I could handle. To test myself, I rotated on trauma surgery with Q4 in-house call. I decided I could handle it, so I went into a surgery residency.

What's ridiculous is that the interns can only work 16 hours, not that the med students can work over 16 hours. This isn't day camp. There is so much to be learned as an intern, and a lot of it happens at night when you're finally the one making decisions on your own. That's all been stripped from them, and I'm not jealous of them at all. Plus, working 5-6 days a week of 12-14 hours a day can suck just as much as some Q4 call.

If you're really completely buffered from call as a student and resident, it's a bit terrifying to think that you might experience your first 30+ hour stretch as an attending.

 

[gravitywave]

The worst thing that could have happened is that I was fooled into thinking that surgery was fun and happy because I was only there from 6a-6p every day, only to become a resident and realize that the call schedule was far worse than I could handle. To test myself, I rotated on trauma surgery with Q4 in-house call. I decided I could handle it, so I went into a surgery residency.

What's ridiculous is that the interns can only work 16 hours, not that the med students can work over 16 hours. This isn't day camp. There is so much to be learned as an intern, and a lot of it happens at night when you're finally the one making decisions on your own. That's all been stripped from them, and I'm not jealous of them at all. Plus, working 5-6 days a week of 12-14 hours a day can suck just as much as some Q4 call.

If you're really completely buffered from call as a student and resident, it's a bit terrifying to think that you might experience your first 30+ hour stretch as an attending.

👍 i was pretty worried about 30 hour shifts as a student/resident until i started talking to people who are on the resident/attending side of things. I'm rapidly coming around to the idea that the latest set of work restrictions are a step too far.

 

[2012mdc]

We did get a fair amount of penetrating trauma and such well into the night, so yes, the experience will vary by location.


My OB call was 25 hours - we'd come in at 6am and leave after 7am sign out the following day.


Newsflash: you won't be working "intern hours" for most of your residency, and if you want to have any idea how you'll handle the majority of your residency, med school is the only way you'll find out.

The worst thing that could have happened is that I was fooled into thinking that surgery was fun and happy because I was only there from 6a-6p every day, only to become a resident and realize that the call schedule was far worse than I could handle. To test myself, I rotated on trauma surgery with Q4 in-house call. I decided I could handle it, so I went into a surgery residency.

What's ridiculous is that the interns can only work 16 hours, not that the med students can work over 16 hours. This isn't day camp. There is so much to be learned as an intern, and a lot of it happens at night when you're finally the one making decisions on your own. That's all been stripped from them, and I'm not jealous of them at all. Plus, working 5-6 days a week of 12-14 hours a day can suck just as much as some Q4 call.

If you're really completely buffered from call as a student and resident, it's a bit terrifying to think that you might experience your first 30+ hour stretch as an attending.

I just don't understand the logic of applying the restrictions to interns only. Obviously I haven't gone through residency yet but I assume nothing magical happens between the last day of PGY1 and the first day of PGY2

 

[ArcGurren]

Overall I actually like 3rd year a lot more than first or second year overall, but I definitely have some gripes.

- Everything about the culture of surgery. The strict hierarchy (which I never really saw on medicine), the general misanthropic pompous nature of both the residents and the attendings, the crappy nature of having to be scrubbed in doing absolutely nothing, the tedious, unnecessarily long hours, and the general one-up-manship culture which really defined the whole thing. I got saddled with the worst kind of residents to have on surgery and some of the worst attendings, and it really ruined my experience. The residents would routinely bias themselves towards helping out the students who explicitly wanted to go into surgery and neglect/belittle the students who said otherwise.

- the complete lack of control over your time and your future. I can't schedule things until a month in advance since I don't know my call schedule; I can't go home on some weekends until I know my call schedule. I've had to miss birthdays and weddings. Overall suckitude.

- Overnight call (especially on trauma service), while a valuable experience, can suck. A lot.

There's probably more in here, but my major gripes are already down.

 

[xanthomondo]

👍 i was pretty worried about 30 hour shifts as a student/resident until i started talking to people who are on the resident/attending side of things. I'm rapidly coming around to the idea that the latest set of work restrictions are a step too far.

I agree with this. I think the restriction should have been 24 hours, not 30 hours. Staying up overnight for call was fine, it was just getting through the entire next day which was horrible and seemed dangerous.

 

[Rollo]

Overall I actually like 3rd year a lot more than first or second year overall, but I definitely have some gripes.

- Everything about the culture of surgery. The strict hierarchy (which I never really saw on medicine), the general misanthropic pompous nature of both the residents and the attendings, the crappy nature of having to be scrubbed in doing absolutely nothing, the tedious, unnecessarily long hours, and the general one-up-manship culture which really defined the whole thing. I got saddled with the worst kind of residents to have on surgery and some of the worst attendings, and it really ruined my experience. The residents would routinely bias themselves towards helping out the students who explicitly wanted to go into surgery and neglect/belittle the students who said otherwise.

- the complete lack of control over your time and your future. I can't schedule things until a month in advance since I don't know my call schedule; I can't go home on some weekends until I know my call schedule. I've had to miss birthdays and weddings. Overall suckitude.

- Overnight call (especially on trauma service), while a valuable experience, can suck. A lot.

There's probably more in here, but my major gripes are already down.

All of this sounds 10x better and more interesting than writing notes all day in medicine about some guy's creatinine level or controlling blood glucose...

 

[45408]

👍 i was pretty worried about 30 hour shifts as a student/resident until i started talking to people who are on the resident/attending side of things. I'm rapidly coming around to the idea that the latest set of work restrictions are a step too far.

Indeed.

I just don't understand the logic of applying the restrictions to interns only. Obviously I haven't gone through residency yet but I assume nothing magical happens between the last day of PGY1 and the first day of PGY2

My guess is that they're just using this as a step to keep advancing it more and more, until no one can do it.

Overall I actually like 3rd year a lot more than first or second year overall, but I definitely have some gripes.

- Everything about the culture of surgery. The strict hierarchy (which I never really saw on medicine), the general misanthropic pompous nature of both the residents and the attendings, the crappy nature of having to be scrubbed in doing absolutely nothing, the tedious, unnecessarily long hours, and the general one-up-manship culture which really defined the whole thing. I got saddled with the worst kind of residents to have on surgery and some of the worst attendings, and it really ruined my experience. The residents would routinely bias themselves towards helping out the students who explicitly wanted to go into surgery and neglect/belittle the students who said otherwise.

While surgery may do this more than other specialties in different places, this is definitely a problem at your institution.

I'm a bit lost as to why all the med students think that (a. it's terrible to be scrubbed into long cases (b. continue to scrub into cases rather than helping with floor work or seeing consults or going to surgery clinic or admitting patients from the ED or the many other things we do in surgery.

- the complete lack of control over your time and your future. I can't schedule things until a month in advance since I don't know my call schedule; I can't go home on some weekends until I know my call schedule. I've had to miss birthdays and weddings. Overall suckitude.

Which is why I managed to go on more vacations in my intern year of residency than the previous 3 years combined...

I agree with this. I think the restriction should have been 24 hours, not 30 hours. Staying up overnight for call was fine, it was just getting through the entire next day which was horrible and seemed dangerous.

Just wait until you're covering a team of patients and you realize just how little you know about your patients when you've been gone a full 24 hours. At least by the mid/late morning when I leave now, I can usually see the trajectory of my patients' care for the day. If I left at the 24 hour mark (6am), I'd be leaving before my attendings had even heard - let alone seen - their patients.

 

[2012mdc]

Indeed.


My guess is that they're just using this as a step to keep advancing it more and more, until no one can do it.


While surgery may do this more than other specialties in different places, this is definitely a problem at your institution.

I'm a bit lost as to why all the med students think that (a. it's terrible to be scrubbed into long cases (b. continue to scrub into cases rather than helping with floor work or seeing consults or going to surgery clinic or admitting patients from the ED or the many other things we do in surgery.


Which is why I managed to go on more vacations in my intern year of residency than the previous 3 years combined...


Just wait until you're covering a team of patients and you realize just how little you know about your patients when you've been gone a full 24 hours. At least by the mid/late morning when I leave now, I can usually see the trajectory of my patients' care for the day. If I left at the 24 hour mark (6am), I'd be leaving before my attendings had even heard - let alone seen - their patients.

At my institution we didn't have much freedom on surgery. There were multiple rooms going on at the same time and each one required a student scrubbed. You only admitted patients if you were on call and on general surgery only one student was on call at a time. Clinic rarely overlapped with OR time as well.

So if you're not into surgery (or even if you are but you are scrubbed with an intern who wants/needs the practice) and you've gotten stuck in your gazillionith mastectomy + lumpectomy it can suck a lot.

Surgery in of itself is not a bad rotation but I feel like many schools mismanage the rotation and ruin the experience. Forcing somebody to be scrubbed in on a 8 hr surgery and then not letting do anything but retract and shutting them down whenever they ask questions is just pointless.

 

[ArcGurren]

All of this sounds 10x better and more interesting than writing notes all day in medicine about some guy's creatinine level or controlling blood glucose...

I like minor procedures but I hate being scrubbed in for hours on end, whether or not I'm doing anything. The surgery lifestyle sucks. And as it turns out, I rather enjoy using my brain to medically manage patients. (Not that surgeons don't use their brains, but it's more technically oriented than detail oriented IMO).

Just because you like something doesn't mean everyone else should find it interesting bub.

 

[ArcGurren]

While surgery may do this more than other specialties in different places, this is definitely a problem at your institution.

I'm a bit lost as to why all the med students think that (a. it's terrible to be scrubbed into long cases (b. continue to scrub into cases rather than helping with floor work or seeing consults or going to surgery clinic or admitting patients from the ED or the many other things we do in surgery.

I would have loved to help out with floor work instead of being scrubbed in for hours doing next to nothing. However, I had no choice in the matter because I was expected to be the b**** of the senior residents (my interns were generally nicer people on the whole). And if it's a problem at my institution, I guarantee you that this is what happens the majority of the time instead of the minority. As you readily admitted, this tends to happen more with surgery than with other specialties; sure you guys do some cool stuff but you cannot blow off the fact that this is a real problem with many places. The culture more than often not sucks. I didn't enjoy getting yelled at continuously for things I didn't do, and I didn't enjoy being judged maliciously for the fact that I wanted to go into another specialty, no matter how much interest I showed. My time spent there would have been better if I could have practiced minor procedures which I could conceivably do on a regular basis with a career in medicine (central lines, foleys, helping place chest tubes, etc) but instead was forced to sit through my 50th lap appy or lap chole learning and doing absolutely nothing.

I even actually had no problem going and seeing surgery consults, even if they were complete BS sometimes, just because I got to use my brain more on an average. That's the kind of medicine I like, diagnostic and cognitive. Surgery had none of that sort of experience for the students. And for what it's worth I rotated at two sites, one which was traditionally malignant and one which was traditionally really good... the really good one still had residents who showed an appalling lack of understanding of medicine during their morning rounds, which they would frequently try to blow off as "well, we're doing 'focused' rounds"... yet somehow the fact that it was focused means you yell at the medical student for including a new onset murmur in your problem list (which was there) instead of reciting the same "out of bed, ambulate, DVT prophylaxis, pain control" nonsense.

Mind you, I enjoyed learning ABOUT surgery. I think the set of diseases, pathology, etc is very fascinating and I think general surgeons are an absolutely necessary profession for whom I have a vast amount of respect. But I don't have to like the way the culture treats the students as a whole. I would love to take care of surgical diseases (esp since I'm interested in GI) were it not for the fact that I physically despise being in the OR personally.

 

[MilkmanAl]

I have to say, it's pretty disheartening to see you drinking that old school work hour Kool-Aid, Prowler. I'm not interested in a debate on the issue, though, so meh. One thing you mentioned jumped out at me, though:

I'm a bit lost as to why all the med students think that (a. it's terrible to be scrubbed into long cases (b. continue to scrub into cases rather than helping with floor work or seeing consults or going to surgery clinic or admitting patients from the ED or the many other things we do in surgery.

It's baffling to me that in less than 2 years, you've apparently managed to forget completely what surgery rotations are like for most med students. Speaking from my personal view and experience, long cases equal long hours of retracting and standing there getting pimped. Yeah, a lot of them are cool - really cool, even - but what enjoyment and education that's there to be had is diluted out by upper body fatigue and often hunger. Floor work is by far worse and more tedious, though. Pick your poison.

 

[da8s0859q]

I'm a bit lost as to why all the med students think that (a. it's terrible to be scrubbed into long cases (b. continue to scrub into cases rather than helping with floor work or seeing consults or going to surgery clinic or admitting patients from the ED or the many other things we do in surgery.

It's baffling to me that in less than 2 years, you've apparently managed to forget completely what surgery rotations are like for most med students.

My first reaction too.

I don't know, maybe he had a better-than-usual experience. My surgery rotation was at a hospital which is thought to be of a much lesser grade of med student surgery malignancy in the area, and I still had to put my head down and count down days until the next day off. Was not a good experience for me, and turned me -- and multiple classmates -- completely off on the idea of becoming surgeons.

 

[olemissbabydoc]

The way things go here, scrubbing in is rule number one. If there's a student in every surgery, THEN whoever is left can take consults/floor work. Without hesitation I'd spend 13 hrs a day chart chasing. Unfortunately I'm not given that option.

 

[medigull]

If you're really completely buffered from call as a student and resident, it's a bit terrifying to think that you might experience your first 30+ hour stretch as an attending.

This right here. Everyone complaining about the hours is in a complete delusion of how physcians work. When you are in the private world and you have call there is no "post call day". You have call all night and guess what....you still have a full schedule of patients for the next day. Its the path everyone in med school chose.

 

[da8s0859q]

This right here. Everyone complaining about the hours is in a complete delusion of how physcians work. When you are in the private world and you have call there is no "post call day". You have call all night and guess what....you still have a full schedule of patients for the next day. Its the path everyone in med school chose.

I am more than willing to work hard, but I am not willing to martyr myself. Fortunately, not every specialty works like you described.

 

[2012mdc]

I am more than willing to work hard, but I am not willing to martyr myself. Fortunately, not every specialty works like you described.

This

 

[turkeyjerky]

This right here. Everyone complaining about the hours is in a complete delusion of how physcians work. When you are in the private world and you have call there is no "post call day". You have call all night and guess what....you still have a full schedule of patients for the next day. Its the path everyone in med school chose.

Seems like you have some delusions as well. Community physicians do not take call every fourth night and they're not in the hospital and awake all night when they do.

 

[Sheldor]

Seems like you have some delusions as well. Community physicians do not take call every fourth night and they're not in the hospital and awake all night when they do.

Agreed, and they are getting paid to work, as opposed to medical students who pay the school/hospital.

 

[45408]

I would have loved to help out with floor work instead of being scrubbed in for hours doing next to nothing. However, I had no choice in the matter because I was expected to be the b**** of the senior residents (my interns were generally nicer people on the whole). And if it's a problem at my institution, I guarantee you that this is what happens the majority of the time instead of the minority. As you readily admitted, this tends to happen more with surgery than with other specialties; sure you guys do some cool stuff but you cannot blow off the fact that this is a real problem with many places.

My n=2, and I doubt yours is much higher.

the really good one still had residents who showed an appalling lack of understanding of medicine during their morning rounds, which they would frequently try to blow off as "well, we're doing 'focused' rounds"... yet somehow the fact that it was focused means you yell at the medical student for including a new onset murmur in your problem list (which was there) instead of reciting the same "out of bed, ambulate, DVT prophylaxis, pain control" nonsense.

1. What murmur?
2. They still have to see all of their patients in very short order, so while someone's interesting new heart tones might merit further investigation later, you also have to make sure that someone else didn't become anuric overnight, which is a lot more likely to result in a real problem.

 

[45408]

I have to say, it's pretty disheartening to see you drinking that old school work hour Kool-Aid, Prowler. I'm not interested in a debate on the issue, though, so meh.

I've been singing pretty much the same tune all along. I have a new perspective, but I guarantee you that in fall of 2008, I was saying "I want to rotate on trauma surgery to test myself and see if I can handle it."

It's baffling to me that in less than 2 years, you've apparently managed to forget completely what surgery rotations are like for most med students. Speaking from my personal view and experience, long cases equal long hours of retracting and standing there getting pimped.

It's baffling to me that you apparently know this much about what my surgery rotations were like. Other than a GYN nightmare that my classmates threw me into (when I wasn't the one who was supposed to be covering gyn cases), I don't think I ever scrubbed into a case >4 hours in med school. Most of my "pimping" was on classic rock.

My first reaction too.

I don't know, maybe he had a better-than-usual experience. My surgery rotation was at a hospital which is thought to be of a much lesser grade of med student surgery malignancy in the area, and I still had to put my head down and count down days until the next day off. Was not a good experience for me, and turned me -- and multiple classmates -- completely off on the idea of becoming surgeons.

I think my community general surgery experience was amazing. Of course, I'm biased now, but I went into the rotation with a very open mind. I remember walking out on at least one occasion thinking "Man, today was awesome!"

Maybe you guys go to school with a bunch of @ssholes, but I went to MCW, which I thought had a phenomenal clinical curriculum for nearly every rotation. Neurology sucked no matter how you slice it though.

Seems like you have some delusions as well. Community physicians do not take call every fourth night and they're not in the hospital and awake all night when they do.

A lot of them are on at least Q4, and many are on for a week at a time.

BUT, I agree on the second half. Many of them have PAs who can go in and admit someone from the ED and just phone it in.





Edit: for those interested, here are my fall 2008 posts regarding my surgery rotations:

LOL. I'm on overnight trauma surgery call - and I don't plan on sleeping - on the weekend, so your plans are toast. We get four days off per month. If there's a weekend at the end of the rotation, you can get lucky.

I doubt s/he means autonomy in the OR, but rather in general. I felt like I had a fairly long leash on most of my rotations. When I was on surgery, I carried the consult pager when on call, and if we got a consult, I'd take the call and talk to the attending/resident. I'd ask everything I wanted to know, tell my senior that I was going to go see this consult, and I'll page him when I'm done. Then I'd go do the consult as thoroughly as I wished. When we got traumas, I had a designated role in the trauma bay - I wasn't shadowing, I was expected to do things (cut off clothes and jewelry, foley, fem stick, rectal). I rounded on my own patients in the morning by myself (someone came by after), and they'd let us do things like remove sutures, staples, etc., and we could help with bigger things like chest tubes.

I thought it was a good mix of supervision and autonomy, and I had a really good time.


As for the OP, yes, it does sound like you're having a terrible experience. I've heard a number of people from many different schools say that their OB/GYN rotation was pretty rough, but from your description of your experiences and your classmates' experiences, it's pretty reasonable for you to expect more from your school.

Well, that was only a glimpse when I shadowed, but I did a month of trauma this year. It was pretty awesome.

The trauma team up here always wears scrubs - in clinic, in lecture, on rounds, in the OR, and in the trauma bay. It was pretty sweet.

 

[2012mdc]

I've been singing pretty much the same tune all along. I have a new perspective, but I guarantee you that in fall of 2008, I was saying "I want to rotate on trauma surgery to test myself and see if I can handle it."


It's baffling to me that you apparently know this much about what my surgery rotations were like. Other than a GYN nightmare that my classmates threw me into (when I wasn't the one who was supposed to be covering gyn cases), I don't think I ever scrubbed into a case >4 hours in med school. Most of my "pimping" was on classic rock.


I think my community general surgery experience was amazing. Of course, I'm biased now, but I went into the rotation with a very open mind. I remember walking out on at least one occasion thinking "Man, today was awesome!"

Maybe you guys go to school with a bunch of @ssholes, but I went to MCW, which I thought had a phenomenal clinical curriculum for nearly every rotation. Neurology sucked no matter how you slice it though.


A lot of them are on at least Q4, and many are on for a week at a time.

BUT, I agree on the second half. Many of them have PAs who can go in and admit someone from the ED and just phone it in.

Sounds like you had a great surgery rotation. Many of the posters here did not and that's where the disconnect comes from. I got lucky and avoided the long surgeries but while 6+ hour cases were not the norm they were not uncommon either.

I understand how surgery rounds operate different than medicine ones but yelling at/chastizing a student for including a new murmur in a problem list is simply ridiculous and that malignant attitude that permeates a lot of surgery programs is what many students take issue with. Of course the murmur could be nothing (there may not be a murmur at all) but there's a mature way to handle that and yelling isn't. I don't mind getting yelled at for making a mistake on something that's common sense or I already learned but getting yelled at for reporting a finding is absurd.

 

[Rollo]

I like minor procedures but I hate being scrubbed in for hours on end, whether or not I'm doing anything. The surgery lifestyle sucks. And as it turns out, I rather enjoy using my brain to medically manage patients. (Not that surgeons don't use their brains, but it's more technically oriented than detail oriented IMO).

Just because you like something doesn't mean everyone else should find it interesting bub.

So in your opinion, technical expertise doesn't require paying attention to details?

Sounds legit...🙄

 

[ArcGurren]

Sounds like you had a great surgery rotation. Many of the posters here did not and that's where the disconnect comes from. I got lucky and avoided the long surgeries but while 6+ hour cases were not the norm they were not uncommon either.

I understand how surgery rounds operate different than medicine ones but yelling at/chastizing a student for including a new murmur in a problem list is simply ridiculous and that malignant attitude that permeates a lot of surgery programs is what many students take issue with. Of course the murmur could be nothing (there may not be a murmur at all) but there's a mature way to handle that and yelling isn't. I don't mind getting yelled at for making a mistake on something that's common sense or I already learned but getting yelled at for reporting a finding is absurd.

Thank you for putting it better than I could have. TheProwler, no doubt you had a much better experience on surgery than I did (I actually rotated on a trauma service myself and I enjoyed the parts that didn't involve the OR) since you obviously went into surgery, but I hope you can understand that your experience is most certainly NOT the norm. I actually did a subspecialty rotation earlier on in the year and rather enjoyed working with the residents and found them to be generally pleasant people (urology) but I didn't enjoy the actual surgery part... so please don't get the idea that I think surgeons are all misanthropes.

(For what it's worth, the murmur turned out to be an existing physical finding which the patient knew about, but the genius resident looking after the patient never bothered to document - or probably even listen for. Tunnel vision. But you can understand that it's not a joke; a new murmur can mean anything from the fact that they're dehydrated and maybe hypovolemic to the idea that they had a silent MI which perforated their IV septum - both of which are bad news and while surgery rounds are certainly more brisk and abbreviated, I wasn't a complete idiot for including it)

 

[ArcGurren]

So in your opinion, technical expertise doesn't require paying attention to details?

Sounds legit...🙄

I didn't say that, though the dichotomy was misleading - I apologize for making it seem that way. That being said, my point still stands - the fact that my residents blew off a physical finding purely because of their tunnel vision shows that they're more concerned about the actual surgical procedure than the overall patient, and while that might be adequate for surgery, I hated taking that approach.

 

[turkeyjerky]

Yeah....so if an MI perf's someone's septum, that $hit ain't gonna be silent.

 

[45408]

I didn't say that, though the dichotomy was misleading - I apologize for making it seem that way. That being said, my point still stands - the fact that my residents blew off a physical finding purely because of their tunnel vision shows that they're more concerned about the actual surgical procedure than the overall patient, and while that might be adequate for surgery, I hated taking that approach.

Yeah, while I'll concede that you may have been with a miserable bunch, I'll strongly disagree with you that general surgeons are more concerned about the procedure than the patient. Maybe that's how it is in ortho, but we calculate FENas, read EKGs, interpret our own CTs/x-rays, manage our ICU patients, and more. We even admit a not-insignificant number of patients that we never operate on, and we manage their medical issues. There are some medical issues that I think we do better with than our hospitalists, because we're more attentive to our patients and check up on them more often than they do.

Also, I have a grade II/VI mid-systolic crescendo/decrescendo murmur when I'm dehydrated that I can hear when I yawn. Your residents were probably looking at other factors that indicate dehydration (BP, HR, UOP, urine color, BUN/Cr, etc).

Yeah....so if an MI perf's someone's septum, that $hit ain't gonna be silent.

Ding ding ding. If you're waiting for a murmur to tell you about a ruptured papillary muscle let alone a septum/wall of the heart, you're going to be a day late and a dollar short.

 

[officedepot]

.

 

[2012mdc]

Yeah, while I'll concede that you may have been with a miserable bunch, I'll strongly disagree with you that general surgeons are more concerned about the procedure than the patient. Maybe that's how it is in ortho, but we calculate FENas, read EKGs, interpret our own CTs/x-rays, manage our ICU patients, and more. We even admit a not-insignificant number of patients that we never operate on, and we manage their medical issues. There are some medical issues that I think we do better with than our hospitalists, because we're more attentive to our patients and check up on them more often than they do.

Also, I have a grade II/VI mid-systolic crescendo/decrescendo murmur when I'm dehydrated that I can hear when I yawn. Your residents were probably looking at other factors that indicate dehydration (BP, HR, UOP, urine color, BUN/Cr, etc).


Ding ding ding. If you're waiting for a murmur to tell you about a ruptured papillary muscle let alone a septum/wall of the heart, you're going to be a day late and a dollar short.

I definitely agree with that. There was definitely more medicine involved in general surgery than I had anticipated.

Different from the ortho notes "Bone broken. I fix. Bone no longer broken". I kid, I kid

 

[Rollo]

I didn't say that, though the dichotomy was misleading - I apologize for making it seem that way. That being said, my point still stands - the fact that my residents blew off a physical finding purely because of their tunnel vision shows that they're more concerned about the actual surgical procedure than the overall patient, and while that might be adequate for surgery, I hated taking that approach.

Different strokes for different folks, I guess. The general surgeon attendings I've worked with are mainly concerned with resolving their patients' acute issues that brought them to the hospital, and more specifically, brought them on the general surgeon service. Now with that being said, doing the actual procedure is half the game...the other half is figuring out IF and WHEN to operate.

I've found that internist don't mind exploring each physical finding or letting the student figure out for themselves what it could mean. It's the nature of internist to consider each, no matter how small, piece of the puzzle and pretty much beat the issue to death. Which is one of the reasons why I could never do internal medicine because I do not care to deal with minute things. I'm much rather concerned with acute crisis and when and how we're going to fix it...none of this, let's try changing the dosage and wait for lab results.

A healthy dose of respect for each field is a good thing. But a little banter here and there keeps things interesting. 😉