What do you do on inpatient rotations?

[gman33]

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So I'm halfway thru my surgery rotation.
On one service we would see patients, round, and then go scrub into some cases. After that, we might see some more patients or go home depending.

On another service, we see patients, round (a lot longer) and then they want us to do mostly floor work. Stuff like writing orders, dc, whatever.
Doesn't seem like there is much educational value to doing paperwork.

I don't really care to argue whether we should be doing this work or not.
Mainly just wondering what people have done.

Thanks.

 

[BigRedder]

So I'm halfway thru my surgery rotation.
On one service we would see patients, round, and then go scrub into some cases. After that, we might see some more patients or go home depending.

On another service, we see patients, round (a lot longer) and then they want us to do mostly floor work. Stuff like writing orders, dc, whatever.
Doesn't seem like there is much educational value to doing paperwork.

I don't really care to argue whether we should be doing this work or not.
Mainly just wondering what people have done.

Thanks.

Someone has to do it, and from what I hear, the shelf has a lot of the floor work aspect to it. More patient management than procedural stuff. I could very well be wrong.

 

[gman33]

I appreciate learning how to manage the patients. I learn that during rounds. The other part is just filling out forms. Not sure much learning takes place during that part.

Again, I'm just curious to see how much of this most people are doing.

 

[BigRedBeta]

Welcome to the rest of your life.

That's what inpatient medicine is. See the patients, create a plan, and then put that plan into effect. That includes discharges, following up on consults, and 'fixing' any new issues that come up during the day. You'll do this on every other inpatient rotation. As you go forward, you'll find out if this something you love or hate. Whatever you decide is fine, there are plenty of people who love being in clinic, some love being in the OR, and others love being on the wards...and those can be some pretty mutually exclusive groups.

Remember that the surgery self is about the MEDICAL management of surgical problems. You are not going to be asked any questions on how to perform a surgery.

 

[azntxn]

i mostly just shadow, answer random pimp questions every now and then, and write fake SOAP notes whenever I feel like it, is this normal? I feel like I'm in high school, just with stethoscope.

 

[Pegasus1731]

i mostly just shadow, answer random pimp questions every now and then, and write fake soap notes whenever i feel like it, is this normal? I feel like i'm in high school, just with stethoscope.

x2

 

[bioteach]

i mostly just shadow, answer random pimp questions every now and then, and write fake SOAP notes whenever I feel like it, is this normal? I feel like I'm in high school, just with stethoscope.

This plus getting yelled at for my scope-handling skills during laproscopic procedures or just retracting silently if its an open procedure.

 

[myhandsarecold]

during inpatient psych, I go in at 6:30 -> read chart, check for any events overnight + any medications administered -> talk to pts, nurses, social worker, PNAs -> prepare for morning conference -> present to the attending -> write notes to be read by attending -> home by 2:30 unless there's a procedure that I need to be in

during inpatient medicine, I go in at 5:00 -> read notes from consultants, etc... check values, talk to nurses, talk to overnight resident -> talk to pts, listen to heart, lungs, abd, check dressings -> present to the intern -> prepare for morning report -> write notes to be read by resident -> home by 3:00 PM unless there's a procedure, discussion, workshop

you can check UptoDate/Epocrates/Washington Manual for any diagnostic, treatment recommendations and if there's any in there that has not been ordered yet, bring it up to your intern.

 

[Gabby]

Remember that the surgery self is about the MEDICAL management of surgical problems. You are not going to be asked any questions on how to perform a surgery.

Does that mean we can opt out of going into the OR and scrubbing in? I shadowed a surgeon prior to med school and I honestly have no desire to go into the OR again.

 

[cpants]

Does that mean we can opt out of going into the OR and scrubbing in? I shadowed a surgeon prior to med school and I honestly have no desire to go into the OR again.

Are you serious?

 

[IHeartNerds]

Does that mean we can opt out of going into the OR and scrubbing in? I shadowed a surgeon prior to med school and I honestly have no desire to go into the OR again.

This may be the only way to fail a gen surgery rotation. On the other hand, showing up and being fun and occasionally helpful in the OR will net you honors from most residents and attendings.

I think you may be falsely assuming that, somehow, the content of a shelf exam should reflect what you do during the rotation. I can safely say that's pretty far from the truth.

 

[Gabby]

Yes, I'm serious. I honestly have no desire to set foot in an OR ever again, especially to stand around and watch and pretend to be interested.

 

[bioteach]

Does that mean we can opt out of going into the OR and scrubbing in? I shadowed a surgeon prior to med school and I honestly have no desire to go into the OR again.

I wish. Nope, you will scrub in, often...anytime my attending is in the OR, I am in the OR. Last thursday we were in the OR from 8 am until 11 pm straight. Every other day that week we were operating at least 4-5 hrs a day (rounds, clinic, etc. rest of the time).

 

[Gabby]

I wish. Nope, you will scrub in, often...anytime my attending is in the OR, I am in the OR. Last thursday we were in the OR from 8 am until 11 pm straight. Every other day that week we were operating at least 4-5 hrs a day (rounds, clinic, etc. rest of the time).

That's too bad. Clinic, rounding, etc. is fine. Being in the OR for 13 hours straight sounds like pure hell to me.

 

[cpants]

Yes, I'm serious. I honestly have no desire to set foot in an OR ever again, especially to stand around and watch and pretend to be interested.

At least you'll have hours of rhabdomyolysis-inducing retraction to keep you busy.

 

[nlax30]

Inpatient rotations have been about the same.... in early to round on my pts and write my progress notes, morning sign out, then maybe a morning lecture, finish rounding, go over plans with resident/intern, sit around and read up on pt until lunch/noon lecture, attending rounds, check on pts, admits throughout the day, go home....

Not going inti surgery but I did enjoy being in the OR and I agree that just not scrubbing in is probably one if the few ways to either fail or get a poor eval. I guess if there are other students you could try and hang back and let others scrub in that are interested but you still risk being called out and getting bad eval.

I'm currently on a radiology rotation at a VA and it's been terrific. Wonderful hours, laid back. And actually really enjoying the interventional rads procedures and basically get to do most of them being the only student.

 

[cpants]

Scrubbing on cases is valuable experience, even if you aren't interested in surgery. Your patients will expect you to have an understanding of what goes on in the OR and to be able to explain their procedure and what to expect. You can see some awesome anatomy in action. Way cooler than the cadaver. You can also get some great practice closing wounds.

 

[Dr Bartlet]

Scrubbing on cases is valuable experience, even if you aren't interested in surgery. Your patients will expect you to have an understanding of what goes on in the OR and to be able to explain their procedure and what to expect. You can see some awesome anatomy in action. Way cooler than the cadaver. You can also get some great practice closing wounds.

I found scrubbing in to be a gigantic waste of time.

 

[cpants]

I found scrubbing in to be a gigantic waste of time.

You probably had a bad attitude about it.

 

[Gabby]

You probably had a bad attitude about it.

????

There are a number of students at my school who hated their surgery rotation and hated scrubbing in. Did they all have bad attitudes?

 

[cpants]

????

There are a number of students at my school who hated their surgery rotation and hated scrubbing in. Did they all have bad attitudes?

Hating it is one thing. I understand that the OR isn't for everyone. But it is not a waste of time.

 

[smq123]

Hating it is one thing. I understand that the OR isn't for everyone. But it is not a waste of time.

Well, if you're on a rotation where you have to hold a retractor in such a way that you can never see anything, or if you're on with a bunch of MS4s that take priority over you in practicing how to close skin, then it might be actually be a waste of time. Don't assume that everyone's surgery rotation was as educational as yours.

Scrubbing in, like anything else, is a valuable experience ONLY if your teachers allow it to be.

 

[Gabby]

Hating it is one thing. I understand that the OR isn't for everyone. But it is not a waste of time.

I haven't rotated yet, but I can tell you that I've heard it's a supreme waste of time from a lot of people, which is why I asked my question in the first place.

 

[cpants]

I haven't rotated yet, but I can tell you that I've heard it's a supreme waste of time from a lot of people, which is why I asked my question in the first place.

Honestly, it is what you make out of it. If you go into it dreading it and have the attitude that it will be a waste of time, you will prove yourself right. If you are interested and enthusiastic and you read about the cases ahead of time, you can get a lot of teaching out of it and have the opportunity to do more than just retract. If you can't see much, ask to see what's going on during a free moment. Some cases are better than others, but over the course of a rotation you should get to see and do plenty if you make an effort.

It's usually painfully obvious who the "medicine" people are that have no interest in surgery and can't wait to get out of there. The surgeons don't want them there either.

 

[Gabby]

It's usually painfully obvious who the "medicine" people are that have no interest in surgery and can't wait to get out of there. The surgeons don't want them there either.

Then why not make each other happy and allow them to shadow the short cases instead of forcing them into the 10-hour cases? The more I hear from people on the surgery rotation, the more I think that if you aren't crazy with excitement for surgery, the residents and attendings will make your life extra miserable just because they can.

 

[cpants]

Then why not make each other happy and allow them to shadow the short cases instead of forcing them into the 10-hour cases? The more I hear from people on the surgery rotation, the more I think that if you aren't crazy with excitement for surgery, the residents and attendings will make your life extra miserable just because they can.

If you want to avoid long cases, you can take steps to do so. Sometimes it's just luck of the draw though. It looks bad if you try to duck out of the Whipple on the patient you worked up for painless jaundice on admission. If it's not your patient, just volunteer for the shorter cases (but try not to screw over classmates). The surgeons in the group will probably be happy to take the longer, more complicated cases.

There are some malignant types out there, but it's not as bad as people make it out to be. A lot of the cases I've seen where students are complaining about poor treatment, they had been called out for doing things like trying to cut out early or showing obvious disinterest in cases, procedures, or other patient care activities. I think you get back what you give, and if you show disrespect, it won't end well for you.

 

[IHeartNerds]

The more I hear from people on the surgery rotation, the more I think that if you aren't crazy with excitement for surgery, the residents and attendings will make your life extra miserable just because they can.

Ironic because the exact same thing happens on Medicine. If you don't drip with enthusiasm, their passive-aggressive nature comes out. Hm, also true for OB/GYN.

We are not beautiful and unique snowflakes. Medical school is what it is. Expect parts that suck, make you miserable, and are generally unpleasant. Is it a perfect system? Absolutely not. But it's the way it is, and you aren't gonna change it.