3rd year Surgery Clerkship: How do you get graded?

[deleted1139416]

On third year surgery rotation right now. I’m killing it during clinic days and rounding - my attending even signs off on my notes as his own without any alternations. I’m also really good at answering his pimping questions and getting to the OR on time and scrubbing in. The scrub techs and staff also really like me.

The only problem is that during the surgeries themselves, I have terrible dexterity. My hand shakes during suctioning, I either retract too hard or not hard enough, etc. What do you guys think? I know that some attendants don’t take dexterity into account when grading you because not everyone goes into surgery.

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[Billiam95]

I either retract too hard or not hard enough, etc

A tale as old as time...

Beginner mistakes are to be expected, just work on improving every day.

 

[operaman]

Every med student shakes and doesn’t know what they’re doing. Quite literally every single one unless they were previously a surgeon in some other country. This continues even in early residency which is why autonomy is a gradual process and you’re trusted with more delicate and complex tasks as the years go on. Your retracting will suck less and less until you actually know how to do the case. Every senior resident gets that epiphany moment when your attending leaves you alone with a Med student or intern to retract and you suddenly realize just how much your attending has been doing with the retractor and how much you still have to learn. That’s about the time you get really good at it.

Students, in addition to being novices, are also under a lot of pressure in the OR and getting put on the spot to do something is nerve wracking which only exacerbates shakes and poor skills. Nobody is grading you on these things.

If you’re annoying and overstepping, rude, etc, then that can ding you. Conversely if you’re disinterested and not engaged then that may come off poorly too. It sounds like you’re striking the right balance and if people like you that’s an excellent sign.

Overall, I judge students on their presentations and their knowledge base, as well as their work ethic and compassion and commitment to patient care. I think those are reasonable things they should be able to do and improve upon as that stage. Judging someone on their retracting the first time they ever held a retractor seems silly.

 

[AnonymousDoctorGuyPerson]

On third year surgery rotation right now. I’m killing it during clinic days and rounding - my attending even signs off on my notes as his own without any alternations. I’m also really good at answering his pimping questions and getting to the OR on time and scrubbing in. The scrub techs and staff also really like me.

The only problem is that during the surgeries themselves, I have terrible dexterity. My hand shakes during suctioning, I either retract too hard or not hard enough, etc. What do you guys think? I know that some attendants don’t take dexterity into account when grading you because not everyone goes into surgery.

On surgery, as a 3rd year rotation, you're not going to be graded on performing surgery. It's about the medicine of it. At least that's what it's supposed to be, but typically it winds up being whether the folks around you like you or not so you'll be fine.

 

[aldol16]

Teamwork. It's all about your contributions to the team and that might not be the same as you being the most knowledgeable or the best at knot-tying. Surgical teams value teamwork because it's what keeps the schedule moving along in a very busy, fast-paced environment. Most of your learning is going to be self-directed so don't expect to be spoon-fed information like on more medical rotations.

 

[deleted1139416]

Teamwork. It's all about your contributions to the team and that might not be the same as you being the most knowledgeable or the best at knot-tying. Surgical teams value teamwork because it's what keeps the schedule moving along in a very busy, fast-paced environment. Most of your learning is going to be self-directed so don't expect to be spoon-fed information like on more medical rotations.

I’ve noticed the opposite LOL. My surgeon loves teaching and explaining everything. Whereas on medicine rotations I got berated for asking questions.

 

[guytakingboards]

On third year surgery rotation right now. I’m killing it during clinic days and rounding - my attending even signs off on my notes as his own without any alternations. I’m also really good at answering his pimping questions and getting to the OR on time and scrubbing in. The scrub techs and staff also really like me.

The only problem is that during the surgeries themselves, I have terrible dexterity. My hand shakes during suctioning, I either retract too hard or not hard enough, etc. What do you guys think? I know that some attendants don’t take dexterity into account when grading you because not everyone goes into surgery.

Sounds like you're doing a great job! As everyone said, don't worry about the hand shaking. Operating is a learned skill and you're just a neophyte in the surgery world now.

FYI, just throwing this out there. He may be rubbing stamping your notes because they're non- revenue generating. I.e. a lot of surgical notes like post-op hospital notes and clinic notes within the global period are considered part of the total operation reimbursement and are not billed separately. As long as the notes are generally factually correct, it may not be worth making a lot of changes. If they were billed as separate encounters like medicine notes are, they might get more scrutiny.

But it sounds like you need to keep up whatever you're doing on that rotation!

 

[throwaway123342]

You get graded based on pure randomness. You can do amazing as a student and land a preceptor who refuses to give out honors. You can do the bare minimum and get a "chill" preceptor who gives everyone honors.

 

[Esmolol]

You get graded based on pure randomness. You can do amazing as a student and land a preceptor who refuses to give out honors. You can do the bare minimum and get a "chill" preceptor who gives everyone honors.

Second that.

 

[Dr. Anonymouss]

Second that.

I had the second preceptor 😅 my peds preceptor was much much harder to impress.