When do residents actually study for cases?

[footpainhealer]

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Hi everyone, I'm a 4th year and I have always had this question, but idk why I've never thought to ask it during rotations.

When did you guys actually study or prepare for cases (as in read Easley, Mann, articles, etc) as residents? Were weekends the only time you guys had sufficient time to prep?

I feel like everywhere I have been during externships, the residents are so busy doing floor stuff, consults, dirty cases, clinic etc., that there was minimal to no time to really study for anything during the day. Obviously they could read it at home after work, but sometimes we'd be there until 6-9pm for cases that attendings liked to perform after their clinic closed. And then there would be some other big case the next morning or day.

That doesn't really leave any time at all for the couple of hours it probably takes to really learn some of the more complex cases since we'd have to be back in at 5-6 am for rounds etc.

So I'm just curious, how did you guys plan study time?

 

[wakaflocka88]

Lol, I know you’re just kidding. Seriously - if a resident wants to maximize their time in 3 years as DYK has said many times, you will learn to prioritize time and work your a** off to be the best version of yourself. What you get out of it is what you’re willing to put into it. There is no right answer. All comes down to your attitude and work ethic.

 

[Feli]

You want to find places where the residents actually work smart and largely autonomous, not just hard.

Your first clue might be the residency programs that triple scrub basic cases or round on inpatients in huge groups like really only infectious disease or pedi oncology or some hero specialties do (assuming it's not a rare interesting F&A case, but that's usually called M&M or grand rounds). They aren't exactly maximizing their efficiency when they travel in packs... it just shows they take too many residents or they have that mistaken belief that working longer hours gets more done. Having more than one person on-call and a couple backup call people is also a sign of the herd of lemmings mentality.

There will be whole-group meetings, but those should be academics approximately weekly... definitely not rounding daily in that way. There will be double/triple scrub big cases (esp director out of respect), but they're not common. For the most part, one third of your residents will be off service any given time. So, you should see the residents basically divide and conquer:
First years: inpatients (hospital/ER/call), bit of surgery and add-ons, bit of studying, most of call
Second years: SURGERY, studying, bit of call or good add-on cases, looking for jobs
Third years: research, studying, best of surgery, admin stuff, leaving early

Rounds should just be a pgy1 or maybe two of them or maybe a pgy1 and a student or two. That is all you need. The attending will get there later and give direction, or you can ask a 2nd year if you truly get stuck or it is a brand new 1st year in July or Aug. 3rd years really have no business on rounds unless they want to talk to the nurse on that floor or something... they have done plenty of rounds for pod and off-service and would just be the pgy1's backup on a really bad emergent surgery or injury from ER.

You have to study when you can... typically when you aren't on call and you are done with your morning surgery. It might be evenings during first year while it is just after lunch time for most 2nd and 3rd year days, but there is always time to study. You can study and watch vids for the upcoming cases or your interest or boards or whatever.

A last, but key, sign to look for is the programs that let residents (esp seniors) can leave when the surgery for the day and other work is done (since they will start very early or stay late other days and balance it out). They might disappear to "library" or "office rotations" or whatever, but if it is 2pm or 3pm and the work is done, they shouldn't be obligated to stay and do nothing. Those places where the residents fear retribution or consequence from a babysitting director or chief or etc if they leave before 4pm or 5pm even on a slow day with little on the surgery schedule and not much to do are still out there, but they shouldn't be the norm and should lose a lot of interest from students.

My program had 4/yr, so it would go something like this... as you see, nearly all except the "floor" resident had substantial time to study at least a bit:
pgy1 inpatients rounds morning and re-round or new consults all day, meet attendings to round, answer ER calls + maybe get to scrub I&D or pop in on a surgery at main hospital
pgy1 hammertoes and neuroma and hammertoes, resident clinic/study afternoon, on call overnight
pgy1 off service
pgy1 off service

pgy2 second assisting with pgy3 with ankle fx block, study afternoon
pgy2 austin weil, Jones fx, hammertoes, look for jobs afternoon
pgy2 ankle scope, austin, TMA, resident clinic/study afternoon
pgy2 off service

pgy3 flatfoot, study a bit for board qual, long lunch, private office clinic afternoon (can leave that early if they want)
pgy3 ankle fx, haglund, bunion, hammertoes (will let pgy2 do), leave early
pgy3 lapidus, research afternoon, leave whenever they get tired of library but have phone on just in case pgy1 gets crazy case from ER
pgy3 off service (might be air quotes, might not... just never know with those 3rd years)

 

[Pronation]

I never read. I would just be like "lol I dunno", and then the attending would pass me the knife to do the case skin to skin.

 

[DYK343]

This Omnicron spike is driving me nuts. All my cases cancelled yesterday due to lack of OR nurses/staff and stuck in the house.

The point of school and externships is to study and learn the material so its easier to apply "on the go" as a resident. Its hard now as a 4th year because you are on externships and likely the first time being put on the spot for a complex case. Knowing what to do the 2nd or 3rd time around is easier than the 1st time around. This is especially true when you have done the case with your attending before and they already taught you their pearls.

If you're a resident scrubbing my case and have not looked at the xrays/imaging and do not have a solid plan of attack you are not getting the blade. That said sometimes you gotta stay up late. Especially as a 1st year. But as Feli pointed out there is usually some time in the day to read or get caught up.

I found and still find journal articles to be more helpful than text to prepare for a case but I do like Easly's book.

Some residencies are a grind with little sleep and long hours. I grew significant amount of grey hair in residency.

Not everyone wants to do hard cases when they get done. I would wager for every 1 DPM that will fix a calc fx you will find 5 that will likely turf it. If its not for you you dont have to do a grind. If sleep and relaxed lifestyle is your thing there are residency programs that fit your bill.

 

[CutsWithFury]

If you are not on call during the week you should treat your week like a work week and prepare for the next day cases the night before. Review pertinent dissection anatomy. Find videos online to review techniques. Review typical instruments to perform the case. I wouldn't get too heavy into text books as for me, personally, it put me asleep. I am more of visual learner. Finding videos and reviewing different ways people do the case was more valuable to me then anything else.

If you are first year and on an off rotation ask your senior resident if you can just double scrub a case. Even if you are doing nothing but retracting you are in the case and can see as many cases as possible. These are key things I don't think a lot of residents do. If they get off early because they are on a off rotation they just take it easy. Personally you are losing valuable time to see more cases and learn more.

I always treated my weekends, when I was not on call, as true weekends. I had fun. I went out. I did tinder. It was awesome...

 

[Sweatshirt]

For about 10 minutes or less an hour before my case

 

[air bud]

Lol just Do a country club residency like I did and you have all the time in the world to study. Trust me that will never catch up to you....

 

[wakaflocka88]

If you are not on call during the week you should treat your week like a work week and prepare for the next day cases the night before. Review pertinent dissection anatomy. Find videos online to review techniques. Review typical instruments to perform the case. I wouldn't get too heavy into text books as for me, personally, it put me asleep. I am more of visual learner. Finding videos and reviewing different ways people do the case was more valuable to me then anything else.

If you are first year and on an off rotation ask your senior resident if you can just double scrub a case. Even if you are doing nothing but retracting you are in the case and can see as many cases as possible. These are key things I don't think a lot of residents do. If they get off early because they are on a off rotation they just take it easy. Personally you are losing valuable time to see more cases and learn more.

I always treated my weekends, when I was not on call, as true weekends. I had fun. I went out. I did tinder. It was awesome...

100% agree. Even in my final year I would either double scrub or observe a case because I wanted to learn as much as I can. I also tried to scrub with ortho as much as I could all 3 years as well, even if it wasn’t all foot and ankle and I definitely learned a lot of pearls too. A couple of the ortho attendings told me if I needed a referral they be happy to provide one. This right here was priceless and my hard work paid off.