October 6, 2021 at 2 PM Eastern/11 AM Pacific
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At my program, every two or three weeks, we would all present the cases we did, comment on anything interesting or anything we did wrong/complications. Then a few attendings would say that I did a terrible job, unacceptable, and my attendings on these cases would just sit back and say nothing. Learned eventually to just say didn't have any interesting cases. Another program we did 15-ish minutes presentation and went in depth on that particular topic. I thought that was helpful.
Complete, and utter BS, grasping for straws. I had to do one on a fib. The patient was a 19 y/o having transphenoidal pituitary surgery. The dumb nurse reported the patient had a fib by misreading the monitor several hours after I was done with the case, and the ekg showed normal sinus rhythm. I got to do a presentation about how to treat a fib with the story ending in my patient never had a fib. They also tried to get me to do a second one. As I was taking over a liver transplant from another resident the patient coded and died, literally while I was getting report. They tried to get me to do an m&m and I just said I have no idea what happened, I hadn’t even taken the case over yet. So many reasons I hate academic medicine with the hatred of a thousand water falls.
has anyone ever seen a 19 year old with a fib?
They tried to get me to do an m&m and I just said I have no idea what happened, I hadn’t even taken the case over yet.
Those are the only ones that get a little lively, but it’s usually because the opposing team tries to deflect 110% of the blame on us and/or makes ridiculous demands that are impossible and unrealistic. And of course they are then called out on it openly. Fortunately we rarely invite guests. Something like...VERY rarely we have a cross m/m, with ob, or gen surg and those are invariably **** shows with services blaming each other for how the case went.
I’m actually shocked to hear places don’t have m and m conferences. That is a sad reality of snowflake culture. I may be wrong but i thought this was an ACGME requirement. M and M is invaluable for exposure to rare events, what to do and not do, and for hearing the true experts in your program openly debate best practices. Additionally, it is critical to learning how to present, discuss, and defend handling of different cases. Decisions need to be picked apart even if it is uncomfortable. As a resident, rare cases should be reviewed in detail for personal improvement meaning the work and understanding of the situation needs to be mastered even if you did not have to present it. It is in your best interest to take the extra steps and present it.
If you think M and M is bad, i would encourage you to sit in on real life peer review board. Cases are reviewed anonymously (at least as anonymous as possible). Decisions are often roasted without representation by the specialty being questioned. I will never forget sitting in on a conference reviewing an ED docs competence for sending home a healthy 19 year old who presented with near syncope at a gas station. Normal vitals in the ED. Later turned out to have a PE. OB/Gyn and Psych were ready to have this guys head on a stick. “It is unacceptable to miss a life threatening diagnosis in a young healthy patient.” As a resident i spoke out and reviewed the criteria for workup of PE. This patient had 0 criteria suggesting further workup was necessary. The review was being done by physicians. I can only imagine what it’s like to have non-physicians attacking in a court room.
If something rare and significant happens in the OR, I strongly believe it is in everyone’s best interest to have the case discussed in open forum.