Discuss trauma surgery

[roja]

You've missed my point. Others have addressed it, but since it's my quote, allow me to explain.

I don't mind eating with my team. I'd love it if we could sit down and have a power lunch and discuss stuff or have a general banter-fest. It'd be great. But that's not the reality of running a service in a program worth its mustard. Most General Surgery services in most programs are extremely busy, and every member of the team has a function. It's too bad that most of the scut falls on the shoulders of the intern, but that's the way our hierarchy works. The statement "Let's go for lunch!" is an intern's non-appreciation for how truly busy we are as a service and that the act of getting together and having lunch would be entirely impossible unless we ignored our clinical duties as surgical residents. So I take issue with the statement because it means that the intern hasn't figured it out yet. He hasn't matured to the level that's expected of him.

If he's hungry -- great. Go to the cafeteria and do a drive thru and eat on the way back upstairs to get $hit done. That's what I did and that's what the guys and gals who came before me did. To suggest that we should do lunch together means that you haven't a clue what's going on and that's what is so disappointing. Not that you are desperately hungry -- that's only human and we are, after all, just demigods.

As I said, it's difficult for anyone but a surgical resident who's been in a position to lead a team and have responsibility for the patients on the service to understand. I surely don't expect most non-surgeons to understand and they don't.

Actually, I think there are plenty of fields that see this. I just think its tolerated more in other fields. Not MY field. or yours. I had to call the IM chiefs the other day because a resident was trying to surf the net, take breaks etc while the rest of the ED was getting HAMMERED. And then the admitting resident tried to dump stone cold stable patients onto one of his other colleagues by requesting a 'screen'. (denied. I had to call his co-screener and tell him that he would either take these patients or my next call would be to his chief and his residency director for incredibly unprofessional behavior).

No one blames people for wanting breaks or to eat. But you don't go take nice long lunches and breaks when your team is working their tail off. Its unprofessional and under it all shows you have no respect or concerns for your colleagues.

---

Members don't see this ad.

 

[Winged Scapula]

I think the crux of the argument lies in your statement roja that these behaviors are more or less tolerated depending on the field. EVERYONE wants a hard-working, diligent resident...but what defines those characteristics is HIGHLY variable.

To that resident surfing the net in the ED, he is probably taking a well justified break in his mind because he thinks he's worked hard. But to others that sort of behavior is not only not tolerated, but widely derided. What constitutes hard work in specialty X may be a slow day on specialty Y.

Btw, what's a screener?

 

[BlondeDocteur]

Just piping up again... are surgery and 'people skills' mutually exclusive? Absolutely not. It's anecdotal evidence, but by far the best attending I have ever had in terms of patient rapport was the surgeon-in-chief at our hospital. He let patients take all of his time that he needed, and truly made sure they understood their disease process and management plan. Like Dre said about his mentor, he is absolutely the physician I've tried to model my subsequent patient interactions on.

But in psychiatry, we students were required to perform 1-hr supportive psychotherapy sessions with each of our patients every day. In neurology and IM, the rounds would usually last till past noon. I know that's many people in this forum's idea of hell, but you can definitely say that they left no stone unturned in an attempt to understand what was going on with the patient. If there's one thing I do dislike about general surgery, it's that (IMHO) the one minute physical exams and 30-s interviews can lead to some sloppy floorwork.

This obviously isn't to tool on surgery, as I've decided to go into it. But it's ridiculous to say that there aren't differences between it and the IM-based fields, and that those differences can't be appealing.

 

[Blade28]

If there's one thing I do dislike about general surgery, it's that (IMHO) the one minute physical exams and 30-s interviews can lead to some sloppy floorwork.

Wait until SICU rounds when each patient can take 10-20 minutes and rounds can take 6-9 hours every day.

 

[SocialistMD]

If there's one thing I do dislike about general surgery, it's that (IMHO) the one minute physical exams and 30-s interviews can lead to some sloppy floorwork.

One thing you'll find as an intern is that those other things aren't (or shouldn't be) glossed over, they just aren't mentioned in the problem list. We still do thorough H&Ps, but don't dig into the 32 year history of hypothyroidism; we simply put them on their home synthroid (or IV synthroid at half the PO dose if the patient is NPO) and move on. It doesn't take an hour to get a thorough H&P, especially in the day and age of electronic records (where the 6-page medicine H&Ps exist in their record ). Part of the difference is the problems we treat can typically be explained by a single anatomic derangement and are not the net sum of fifteen different systems working against the patient.

 

[Blade28]

Reason #6 that I passed on Internal Medicine . . . oops, I mean General Surgery. Sorry, I get the two confused a lot.

Damn it.

(General Surgery? Just a means to an end, my friend. A means to an end.)

 

[roja]

I think the crux of the argument lies in your statement roja that these behaviors are more or less tolerated depending on the field. EVERYONE wants a hard-working, diligent resident...but what defines those characteristics is HIGHLY variable.

To that resident surfing the net in the ED, he is probably taking a well justified break in his mind because he thinks he's worked hard. But to others that sort of behavior is not only not tolerated, but widely derided. What constitutes hard work in specialty X may be a slow day on specialty Y.

Btw, what's a screener?

Absolutely. However, since we are a reasonably 'tight' hospital (meaning a good percentage of our services actually get along really well), it was well known that this person was a problem both in the ED and on IM services. And really, although it is true that what is busy is relative to the service, if you see everyone else around you busting their humps, YOU probably should be busting your hump.

Take tonight for example, the ED is a wreck. We just had a prolonged MASSIVE GI bleeder that brought the entire ED to a standstill. Mix in the 30 or so other regular patients waiting to be seen and the two stab wounds that walked in, and well, I haven't taken a break and niether have my residents. And I stapled wounds, etc even though as an attending, this is usual 'intern' work. When everyone is busting, you bust. period. (I have a firm work ethic belief).

A screener in our hospital is a senior med resident who 'screen's patients for the ICU. So, if anyone is going to the ICU, we run these cases by the resident. It occasionally happens that the regular admitting resident tries to off load some of the work by asking for a screen.

 

[Winged Scapula]

Absolutely. However, since we are a reasonably 'tight' hospital (meaning a good percentage of our services actually get along really well), it was well known that this person was a problem both in the ED and on IM services. And really, although it is true that what is busy is relative to the service, if you see everyone else around you busting their humps, YOU probably should be busting your hump.

True, some people are amazingly oblivious to these things.

Take tonight for example, the ED is a wreck. We just had a prolonged MASSIVE GI bleeder that brought the entire ED to a standstill. Mix in the 30 or so other regular patients waiting to be seen and the two stab wounds that walked in, and well, I haven't taken a break and niether have my residents. And I stapled wounds, etc even though as an attending, this is usual 'intern' work. When everyone is busting, you bust. period. (I have a firm work ethic belief).

Yet here you are, on SDN!

A screener in our hospital is a senior med resident who 'screen's patients for the ICU. So, if anyone is going to the ICU, we run these cases by the resident. It occasionally happens that the regular admitting resident tries to off load some of the work by asking for a screen.

Huh. So just makes sure the ICU admit is legit? Interesting.

 

[roja]

True, some people are amazingly oblivious to these things.



Yet here you are, on SDN!



Huh. So just makes sure the ICU admit is legit? Interesting.

Thankfully, as its almost 2am on a weds night, it is now slowed down and I have caught up on all my charts, etc. phew. It has been a nightmare few nights.

I actually don't think this particular guy was oblivious. I think it was intentional and lazy. He actually told his senior that he didn't see why he had to see patients because he was being treated like an intern and his plans were being changed. (and 90% of most IM residents rotating in the Ed are at intern level)

they don't just determine 'legit'. Its mostly a learning position for them, with regards to critical care. We determine if we think the patient needs to be screened in or not, and they evaluate the patient and talk to the fellow/attending. the ED attending will then either agree or not and if necessary talk to the attending. It gets silly when a resident tries to 'refuse to take a patient' on the floors as they aren't allowed. The guy was just being lazy and trying to dump on a colleague. Another type of lazy that annoys the hell out of me.

 

[Ypo.]

Unfortunately most medical students don't graduate into a surgical internship knowing how it's done, and so the process of converting and indoctrinating an intern into the fellowship of surgeons can be quite painful. Trust me in that if it were all about sitting around a campfire eating smores and singing folk songs, your future surgeons won't give a damn whether you live or die postop.

I think I see your point. I can also see some of what Kikaku is arguing.


I will add what my own experience was as a third year student. The first part of my surgery rotation I hated. And it was not because I had to be there early, stay late, work hard, or be reprimanded for things that mattered to patient care. Honestly; that part was the easiest to deal with. The part that made me dread coming in was because people were nasty. The residents talked horribly about each other the second one of them walked out the door. They talked horribly about the attendings, and about the patients. And the fights between the ER residents and the surgery residents were horrific. I remember one night when the surgery intern was having a loud argument with the ER attending right in front of me and how awkward it was. And the sad thing was that it trickled down to us; all the ER residents hated the students on the surgery rotation (maybe simply because they couldn't be sure if we were going into surgery or not?).

The last few weeks of the rotation (on the trauma service, ironically) were a lot better, and it was not because the hours changed. It was because the residents I was working with were humane and respectful and actually got along with each other. I didn't dread coming to work in the morning. I wasn't afraid of being yelled at every second of the day. And I wasn't miserable. And I felt more motivated to please the residents, simply because I felt it was possible to please them.

In this program, residents and students (including myself) were yelled at and ridiculed for honest, first-time mistakes that probably did not matter much to patient care. It was so bad that I saw residents covering up mistakes when the chief wasn't around rather than owning up to them. And the M&Ms were a joke. I felt so bad for the residents. Their job was basically to say what went wrong even though most of the time it was the attendings who made the decision, and to do it in a way that did not make the attending look bad, and then to get publicly reamed for a good half hour about why they didn't do this or that (when most of the time, as far as I could tell, they were only following orders from above).

Now, maybe I'm missing something here, but to me the malignant culture in the program was unnecessary and actually at times detrimental to patient care. I'm not talking about pimping (necessary because you have to be able to think under pressure as a surgeon), or being yelled at for being lazy, or being yelled at for something that really matters to patient care. I understand the need to toughen up, and I don't feel that to complain about that is warranted. I also learned a lot on the rotation; I saw a lot of sick patients, and it was an invaluable experience even if it was a painful one. I just did not like the fact that every day you are dealing with life and death issues on the one hand, and hatred, backstabbing and misery among the team on the other. (for me, having a patient die is really hard and I also happen to think that kicking someone when they are down yet doing their best is one of the worst things you can do for team morale). There were several surgery residents in particular who the whole group talked disparagingly about whenever there was a chance. And that's not even to mention the rotating ER interns (that was a total feeding frenzy). And the other weird thing was that quite a few of the residents never smiled! If you smiled at one of them, they gave you a grimace or a smirk in return. It was definitely strange. Although to be completely fair some of the residents were also very professional, very humane, and were nice to work with.

So maybe I'm not tough enough for a surgical residency. Or maybe the simple truth is that I just don't like the OR enough to put up with all the rest of it. Although I really do respect surgeons (well, most of them) and appreciate the job they do and how hard the lifestyle is.

So in a way, surgery has definitely weeded me out and it's probably for the best as I would truly be miserable in such a residency. I will add that my opinions are shared; none of the students who did a rotation there this year are going into surgery. So maybe it is a more malignant program than most. It's hard for me to know since I have nothing to compare it to.

 

[Miami_med]

I think I see your point. I can also see some of what Kikaku is arguing.


I will add what my own experience was as a third year student. The first part of my surgery rotation I hated. And it was not because I had to be there early, stay late, work hard, or be reprimanded for things that mattered to patient care. Honestly; that part was the easiest to deal with. The part that made me dread coming in was because people were nasty. The residents talked horribly about each other the second one of them walked out the door. They talked horribly about the attendings, and about the patients. And the fights between the ER residents and the surgery residents were horrific. I remember one night when the surgery intern was having a loud argument with the ER attending right in front of me and how awkward it was. And the sad thing was that it trickled down to us; all the ER residents hated the students on the surgery rotation (maybe simply because they couldn't be sure if we were going into surgery or not?).

The last few weeks of the rotation (on the trauma service, ironically) were a lot better, and it was not because the hours changed. It was because the residents I was working with were humane and respectful and actually got along with each other. I didn't dread coming to work in the morning. I wasn't afraid of being yelled at every second of the day. And I wasn't miserable. And I felt more motivated to please the residents, simply because I felt it was possible to please them.

In this program, residents and students (including myself) were yelled at and ridiculed for honest, first-time mistakes that probably did not matter much to patient care. It was so bad that I saw residents covering up mistakes when the chief wasn't around rather than owning up to them. And the M&Ms were a joke. I felt so bad for the residents. Their job was basically to say what went wrong even though most of the time it was the attendings who made the decision, and to do it in a way that did not make the attending look bad, and then to get publicly reamed for a good half hour about why they didn't do this or that (when most of the time, as far as I could tell, they were only following orders from above).

Now, maybe I'm missing something here, but to me the malignant culture in the program was unnecessary and actually at times detrimental to patient care. I'm not talking about pimping (necessary because you have to be able to think under pressure as a surgeon), or being yelled at for being lazy, or being yelled at for something that really matters to patient care. I understand the need to toughen up, and I don't feel that to complain about that is warranted. I also learned a lot on the rotation; I saw a lot of sick patients, and it was an invaluable experience even if it was a painful one. I just did not like the fact that every day you are dealing with life and death issues on the one hand, and hatred, backstabbing and misery among the team on the other. (for me, having a patient die is really hard and I also happen to think that kicking someone when they are down yet doing their best is one of the worst things you can do for team morale). There were several surgery residents in particular who the whole group talked disparagingly about whenever there was a chance. And that’s not even to mention the rotating ER interns (that was a total feeding frenzy). And the other weird thing was that quite a few of the residents never smiled! If you smiled at one of them, they gave you a grimace or a smirk in return. It was definitely strange. Although to be completely fair some of the residents were also very professional, very humane, and were nice to work with.

So maybe I'm not tough enough for a surgical residency. Or maybe the simple truth is that I just don't like the OR enough to put up with all the rest of it. Although I really do respect surgeons (well, most of them) and appreciate the job they do and how hard the lifestyle is.

So in a way, surgery has definitely weeded me out and it's probably for the best as I would truly be miserable in such a residency. I will add that my opinions are shared; none of the students who did a rotation there this year are going into surgery. So maybe it is a more malignant program than most. It's hard for me to know since I have nothing to compare it to.

With a couple of small exceptions, most of the residents got along well here. I don't think that everyone hating each other is a universal surgery thing. On the contrary, I think that on the more complicated services, the comraderie improved over many of our other programs out of necessity.

 

[roja]

I have to concur with Miami_med. You can't draw broad statements from one institutions service. Where I went to med school, surgery was not malignant. The residents got along well. Same at where I did residency and at Jackson in Miami. I have friends in surgical residencies in other places, and they are decidely unmalignant. Granted, there are definately places where I am sure it is.

 

[Winged Scapula]

Echo my agreement. As much as I complained about my residency program and its weaknesses, the ability of the residents to get along was not one of them. Save for a couple of jerks (who were gone after my intern year), we all worked well together and socialized outside of the hospital. As a matter of fact, one of my former co-Chiefs is coming to town with his fiancee for a visit.

Programs where the residents badmouth each other and belittle the medical students and faculty are certainly not representative of all surgical programs and its unfortunate that it has given at least one person a skewed view of surgery as a profession.

 

[roja]

Echo my agreement. As much as I complained about my residency program and its weaknesses, the ability of the residents to get along was not one of them. Save for a couple of jerks (who were gone after my intern year), we all worked well together and socialized outside of the hospital. As a matter of fact, one of my former co-Chiefs is coming to town with his fiancee for a visit.

Programs where the residents badmouth each other and belittle the medical students and faculty are certainly not representative of all surgical programs and its unfortunate that it has given at least one person a skewed view of surgery as a profession.

I think all this agreement is becoming a trend.

 

[Winged Scapula]

I think all this agreement is becoming a trend.

Yeah, who woulda thunk it?

A new era of mutual respect and cooperation between EM and Surgery, eh?

 

[roja]

Of course. Just tell me you drink (good) coffee.

 

[Winged Scapula]

Of course. Just tell me you drink (good) coffee.

Sorry, I don't drink coffee, as much as I like the taste in ice cream and candy. I'm a diet caffeinated soda and energy drink consumer.

I guess we have to be relegated to enemies.

 

[roja]

Sorry, I don't drink coffee, as much as I like the taste in ice cream and candy. I'm a diet caffeinated soda and energy drink consumer.

I guess we have to be relegated to enemies.

Or just agree to disagree. I would have worried had we agreed on everything.

 

[Ypo.]

Well, it's comforting to know that at least one ER doc and one surgeon out there can get along.

 

[roja]

Oh, there are several. Our head of trauma surgery gets along with most of the ED attendings. (course it doesn't hurt that he is one of the most attractive men on the planet) And my best friend and I (also ED) got along fabulously with all the surgeons in Miami.

Most of our ED residents and surgical residents get along very well.

 

[Miami_med]

Oh, there are several. Our head of trauma surgery gets along with most of the ED attendings. (course it doesn't hurt that he is one of the most attractive men on the planet) And my best friend and I (also ED) got along fabulously with all the surgeons in Miami.

Most of our ED residents and surgical residents get along very well.

Maybe Miami is just a bastion of mutual respect and caring (OK I really can't keep a straight face saying that).

In all actuality though, when I rotated through trauma down here, we had a conglomeration of UM surgery residents, army training physicians of various types, EM residents from the DO program at Sinai on the beach, and rotating EM residents from Michigan (I know we also get some from NY). Considering that the service is completely nuts, and there is no logical reason why all of these people who don't know each other at all should get along, everyone got along amazingly well. Maybe it's the fact that we're so used to dealing with the residents in our own ED (which are largely off service residents who don't want to be there since we don't have an EM program), that EM training physicians who actually want to engage in the logical role of an EM physician in the trauma bay are like a breath of fresh air.

 

[roja]

Maybe Miami is just a bastion of mutual respect and caring (OK I really can't keep a straight face saying that).

In all actuality though, when I rotated through trauma down here, we had a conglomeration of UM surgery residents, army training physicians of various types, EM residents from the DO program at Sinai on the beach, and rotating EM residents from Michigan (I know we also get some from NY). Considering that the service is completely nuts, and there is no logical reason why all of these people who don't know each other at all should get along, everyone got along amazingly well. Maybe it's the fact that we're so used to dealing with the residents in our own ED (which are largely off service residents who don't want to be there since we don't have an EM program), that EM training physicians who actually want to engage in the logical role of an EM physician in the trauma bay are like a breath of fresh air.

Very true. Of course, after taking some of the consults from the ED, I rapidly learned why EM training was a breath of fresh air. about 1/2 the staff there is 'true EM', the other half is, well terrifying.

 

[VoiceofReason]

I completely understand everything said in this thread. Hey, I'm not averse to working hard, in fact I think I'd relish it, to a point. And this is what has me shying away from surgery lately. My parents instilled good living habits in me literally my entire life -- for example, I cook for myself not much less than every day, I maintain a very rigorous exercise routine, and I get good sleep almost at all costs. All these things are second nature to me, I actually hate the taste of unhealthy foods and I feel like a bum if i miss a day of exercise. In short, I like to feel healthy, fit, and well rested as much as possible.

It's not that I don't love the idea of pushing myself hard in training for the priviledge of operating.. I just value my general well-being a little more. I know blade has said that it's possible to exercise and cook even during surgery residency, but I don't want to just barely be able to do it... as in, you finished your work day and now have 5 hours before your next one starts, now peel yourself off the floor of your apartment and go lift weights and run three 7 minute miles. Yeah, sure. Surgical residency is actually unhealthy, and that's where I draw the line.

edit: and i know all residencies are pretty brutal. but i perceive the others as less exhausting overall.

 

[Blade28]

I know blade has said that it's possible to exercise and cook even during surgery residency, but I don't want to just barely be able to do it... as in, you finished your work day and now have 5 hours before your next one starts, now peel yourself off the floor of your apartment and go lift weights and run three 7 minute miles. Yeah, sure. Surgical residency is actually unhealthy, and that's where I draw the line.

It's not THAT bad! I usually run anywhere from 10-12 minute miles when I go for my runs, and log 15-20 miles a week.

Most days I'll get home between 6-8 and go back to work the next morning somewhere between 4-6. So that's, what, 8-12 hours at home each night?

 

[Winged Scapula]

Yeah, in the "old days" that would happen (and has even happened to me after work hour restrictions).

But VoR should know that if a program is serious about adhering to work hours, that you are required to have a 10 hour period off between "shifts" at the hospital, so there should be very few, if any, 5 hrs between leaving and going back (home call not withstanding).

10 hrs is still not enough to get me to run a mile but at least that would be enough time!

 

[dienekes88]

It's not THAT bad! I usually run anywhere from 10-12 minute miles when I go for my runs, and log 15-20 miles a week.

Most days I'll get home between 6-8 and go back to work the next morning somewhere between 4-6. So that's, what, 8-12 hours at home each night?

Don't you also lift?

Hey... 168 hours in a week. If you work 85 hours, you've got 83 hours for the rest of your life. I think TRAMD said that. Easy for me to say, though.

I know a 3rd year medical student who still races bikes at the elite level (professional/category 1). I realize that 3rd year != residency. However, she trains enough that she still murders the competition. Fearsome sprint, legs to get in the late break, and lungs to hold the long break. Amazing.

 

[Blade28]

Don't you also lift?

Hey... 168 hours in a week. If you work 85 hours, you've got 83 hours for the rest of your life. I think TRAMD said that. Easy for me to say, though.

I know a 3rd year medical student who still races bikes at the elite level (professional/category 1). I realize that 3rd year != residency. However, she trains enough that she still murders the competition. Fearsome sprint, legs to get in the late break, and lungs to hold the long break. Amazing.

(1) Yup, 2-3 times a week, 45-60 minutes each time. It really helps that I have a gym at my apartment complex.

(2) Think that's amazing? We had two amazing residents here - one runs marathons regularly and just ran the Boston Marathon ( ) recently! The other one regularly competes in triathalons and just finished the Ironman Triathalon ( ) in Hawaii!

 

[dienekes88]

(1) Yup, 2-3 times a week, 45-60 minutes each time. It really helps that I have a gym at my apartment complex.

(2) Think that's amazing? We had two amazing residents here - one runs marathons regularly and just ran the Boston Marathon ( ) recently! The other one regularly competes in triathalons and just finished the Ironman Triathalon ( ) in Hawaii!

DANG! Impressive!!!

That just reminded me of this Rads resident who told me he had done 9 Ironmans between med school and residency (I verified this by searching results, because I thought he was full of crap). I think he had one Kona under his belt. That prompted a "wtf, mate, I thought you were supposed to be reading or something."

 

[VoiceofReason]

It's not THAT bad! I usually run anywhere from 10-12 minute miles when I go for my runs, and log 15-20 miles a week.

Most days I'll get home between 6-8 and go back to work the next morning somewhere between 4-6. So that's, what, 8-12 hours at home each night?

man, it's like one minute i can see myself doing that and then 30 seconds later i'm like no it's just slightly too much.. it's seriously the most difficult decision I can really remember having to make.

now that home time isn't all R&R though right, do you fit your reading in during those hours?

Yeah, in the "old days" that would happen (and has even happened to me after work hour restrictions).

But VoR should know that if a program is serious about adhering to work hours, that you are required to have a 10 hour period off between "shifts" at the hospital, so there should be very few, if any, 5 hrs between leaving and going back (home call not withstanding).

10 hrs is still not enough to get me to run a mile but at least that would be enough time!

really? I thought I remembered reading that it was a recommendation to be included with the new (56 hour) work hour restrictions. Guess I'm misremembering.

and I'd be more likely to find adherance to that at a community program? Thanks for the info btw.

 

[BlondeDocteur]

It's crazy what people find time to do-- and I usually find the surgical residents are doing the most outside of the hospital, particularly when it comes to athletics.

I'd venture to say Dienekes and I know the same 3rd yr student, and she is amazing. She was a pro before med school and has kept it up. I'd also say between 1/3 and 1/2 of my medical school class has trained for and run at least one marathon while in school (my pitiful self included). Loads of weekend warrior / work hard, play hard types.

In short, people make it work. And that includes less glamorous stuff like having kids and hanging out with them, too.

 

[dienekes88]

It's crazy what people find time to do-- and I usually find the surgical residents are doing the most outside of the hospital, particularly when it comes to athletics.

I'd venture to say Dienekes and I know the same 3rd yr student, and she is amazing. She was a pro before med school and has kept it up. I'd also say between 1/3 and 1/2 of my medical school class has trained for and run at least one marathon while in school (my pitiful self included). Loads of weekend warrior / work hard, play hard types.

In short, people make it work. And that includes less glamorous stuff like having kids and hanging out with them, too.

Yep. Same person.

 

[Blade28]

now that home time isn't all R&R though right, do you fit your reading in during those hours?

really? I thought I remembered reading that it was a recommendation to be included with the new (56 hour) work hour restrictions. Guess I'm misremembering.

(1) Yup - My previous goal was to read 10 pages of Sabiston's a day, every day, no matter what. Now this wouldn't always happen but usually I managed to squeeze it out (takes around 20-30 minutes of concentration for me to read 10 pages). But now that I've finished the book I'm just working on ABSITE review materials.

On days when I know what cases I have scheduled for the next day, I'll read up on them in Sabiston's or Zollinger's (my surgical atlas) so I don't look like a complete idiot in the OR.

(2) You're supposed to get 10 hours off in between working at the hospital, yes. Current rule.

It's crazy what people find time to do-- and I usually find the surgical residents are doing the most outside of the hospital, particularly when it comes to athletics.

Naturally I'm biased, but some of the very busy surgery residents become very proficient at time management and prioritizing. So they may be better at managing their free time as well - plus who wants an overweight, unhealthy surgeon? Certainly your feet, legs and lower back won't appreciate your obesity during those long OR cases!

 

[Blade28]

man, it's like one minute i can see myself doing that and then 30 seconds later i'm like no it's just slightly too much.. it's seriously the most difficult decision I can really remember having to make.

Hang on a sec...I just remembered one of your older threads (on CT Surg) and realized you're waiting to start your MS-I year. So don't agonize over this NOW! You still have a while to go before your MS-III rotations...why not just keep an open mind and see what you like at that time?

No sense needlessly worrying about this now! You should be enjoying the rest of your summer!

 

[Winged Scapula]

really? I thought I remembered reading that it was a recommendation to be included with the new (56 hour) work hour restrictions. Guess I'm misremembering.

You are indeed misremembering. The 10 hour rest period has been in place since the 80 hour workweek was regulated: http://www.acgme.org/acwebsite/dutyhours/dh_lang703.pdf (see D3)

and I'd be more likely to find adherance to that at a community program? Thanks for the info btw.

No, not necessarily. There are some community programs which go over hours and some academic ones that never do. Its a function of faculty buy-in, census, resident workload and hospital administration helping to reduce the latter by hiring midlevels. I don't think you can make a sweeping generalization about community versus academic, although the conventional wisdom or thought is the same as yours.

 

[VoiceofReason]

Hang on a sec...I just remembered one of your older threads (on CT Surg) and realized you're waiting to start your MS-I year. So don't agonize over this NOW! You still have a while to go before your MS-III rotations...why not just keep an open mind and see what you like at that time?

No sense needlessly worrying about this now! You should be enjoying the rest of your summer!

lol it's so much harder said than done. I am enjoying my free time, though, I promise, I just can't keep these thoughts out of my head. But even though I can't stop thinking about it and researching things, it's hardly causing me distress -- it's more a pleasant dilemma, actually, because I'm still riding the high from my acceptance phonecalls and the knowledge that I made it this far.

 

[FDNewbie]

BTW: you are crazy if you want to waste all your years of surgical training to do trauma. Think of this- 5yrs of general surgery residency- then a 1 (or 2) yr NON OPERATIVE fellowship, followed by a NON OPERATIVE career.

When will you learn to operate? on who? How will you keep up your skills?
doing emergency general? the garbage surgery at nite (appy, dead bowel) so the real surgeons can stay in bed? have fun with these cases.

Being an ICU jockey? might as well just do medicine- its shorter
Plus trauma does ALOT of babysitting for neurosurg, and ortho.

I guess it all depends on how you portray it. I did Trauma for 4 consecutive months..and while it's true, my first day off was day 14, and my second day off was day 26 (then I had two consecutive days off at the end of the month), I loved EVERY SINGLE minute of it.

While the fellowship CAN be mostly non-op, the career can and usually IS filled with WORTHWHILE OR time. Trauma/Critical Care is quickly becoming "Acute Care" surgery, so the Trauma docs are indeed taking Gen Surg call to keep up their skillsets, because yes, most trauma is non-operative. But when we operate, WE OPERATE. It's the REAL deal, no holds barred. The MOST INTENSE and most invasive surgeries I've been in were BLUNT TRAUMA cases that resulted in ex-laps + mediastinotomies/mediasternotomies.

And for me, I actually PREFER the Surgical Critical Care (Trauma ICU), where it's typically a closed unit with fewer (albeit sicker) patients, which is where you really get to ACTUALLY practice that long-forgotten thing called MEDICINE See, I'm of the school of thought that sees us as Surgeons AND Physicians. And if you're a procedure freak like me, there's a TON of stuff to do in the unit. Central lines, trachs, pegs, bronchs, etc. And you'll get your share of codes, cutdowns, etc. It's def. good stuff. Then in the mix, you'll get a few great traumas that go to the OR. Heck, if you ask me, I like the healthy mix of patient care + OR time vs. going from OR to OR, back to back. So Trauma offers the perfect match for me in that respect.

Oh and yes it's true, there's a lot of babysitting for Neuro & Ortho, but that's highly service-dependent. If you're on a service where the Trauma doc is assertive, if there's nothing surgical in the patient, he'll transfer 'em to Ortho (yes, they DO actually have a patient census & ward, believe it or not) or Neuro. You bet that's what I'll be doing when I'm running my own service.

In short, Trauma & Critical Care have a LOT to offer, if that's what appeals to you. A heck of a lot more excitement and variety than Gen Surg or any other surgical subspeciality IMO, as well as the thrill of working under pressure and seeing the sickest and most critical patients, and being able to make an instant & noticeable impact on their life, right then and there.

Sure, all this comes at the cost of more hours and less free time, but if it's your passion, what calls to you...if you're like me and CRAVE hearing the trauma codes come in to run and respond to, then guess what? All those "long hours" will go by so fast and unnoticed, because you're doing what you love and are passionate about. Otherwise, I'd def. do something else, cuz Trauma def. isn't for everyone.

That's my $0.02...

 

[Winged Scapula]

Get back to us after residency and fellowship when those middle of the night phone calls, dirtbag patients and dealing with social work and Ortho/Neuro who WON'T take your patient (regardless of how you run your unit) grows very wearisome.

 

[FDNewbie]

Get back to us after residency and fellowship when those middle of the night phone calls, dirtbag patients and dealing with social work and Ortho/Neuro who WON'T take your patient (regardless of how you run your unit) grows very wearisome.

You're right; there's only one way to find out... But I can also tell ya that a lot of that which we love also involves a lot of which we hate...but we still love it nonetheless. Depends on how deep-seated your love is for it

 

[Winged Scapula]

I'm just saying....

(coming from someone who, as a medical student, wanted a purely academic surgical career, and never cared about going home). Things change and what was once a minor annoyance (ie, your SO's habit of chewing with their mouth slightly ajar) becomes a MAJOR problem a few years later. Same thing with careers.

 

[FDNewbie]

Oh I believe you. I've been warned NUMEROUS times that I'll "grow out of it" or the thrill/excitement will "wear off" soon 'nuff. Or like you're saying, the negatives will pile up to eventually outweigh the positives. Hopefully that won't be the case, because then I really won't know what to do then (nothing else interests me).

I also believe it's highly variable based on where you practice. I'll def agree, most of the major trauma centers are typical of the experience you and others have portrayed. But there are a few here and there that uniquely combine a lot of the positives w/ very few of the negatives. INOVA Fairfax would top that list from my experience...and this is coming from someone who's also been to Shock Trauma...

 

[Winged Scapula]

Oh I believe you. I've been warned NUMEROUS times that I'll "grow out of it" or the thrill/excitement will "wear off" soon 'nuff. Or like you're saying, the negatives will pile up to eventually outweigh the positives. Hopefully that won't be the case, because then I really won't know what to do then (nothing else interests me).

I also believe it's highly variable based on where you practice. I'll def agree, most of the major trauma centers are typical of the experience you and others have portrayed. But there are a few here and there that uniquely combine a lot of the positives w/ very few of the negatives. INOVA Fairfax would top that list from my experience...and this is coming from someone who's also been to Shock Trauma...

I've been to those places as well. And while yes, my love of trauma does not come anywhere near yours, especially after years of residency, my POV is also based on that of my ex-SO who is a Trauma Surgeon having trained at Shock. He says the same thing I'm saying...there is very little reward for what you put in.

I hope I'm wrong because we need people like you who can keep the fires burning for decades.

 

[FDNewbie]

I've been to those places as well. And while yes, my love of trauma does not come anywhere near yours, especially after years of residency, my POV is also based on that of my ex-SO who is a Trauma Surgeon having trained at Shock. He says the same thing I'm saying...there is very little reward for what you put in.

I hope I'm wrong because we need people like you who can keep the fires burning for decades.

Careful, cuz you're doin a good job at dissuading me

 

[Winged Scapula]

Careful, cuz you're doin a good job at dissuading me

Not trying to honestly...just don't want you to romanticize something which doesn't necessarily deserve to be so.

We see a lot of starry eyed pre-meds and med students here who glamourize Trauma and almost without exception, those going into surgery, soon lose that love for it.

But obviously someone's doing the fellowships and someone is still working as a Trauma Surgeon and loving it. Maybe if you were a Scalea and got some fame from the job, the hassles would be worth it.

 

[Blade28]

I'm just saying....

(coming from someone who, as a medical student, wanted a purely academic surgical career, and never cared about going home). Things change and what was once a minor annoyance (ie, your SO's habit of chewing with their mouth slightly ajar) becomes a MAJOR problem a few years later. Same thing with careers.

As posted in the above quote, many of us start off liking the "rush" of an exciting code or procedure...whatever may cause a flurry of action.

But trust me, it can get old VERY quickly.

(All this coming from someone decidedly NOT going into a lifestyle field, and who indeed needs lots of OR time and sick patients in the ICU to keep motivated...)

If by halfway through your G Surg residency you're still gung-ho about Trauma, more power to you! We need people like you.

But the pain of all that non-op work, the terrible patient population, seeing the absolute dregs of society (drunks, drug-users, criminals, domestic violence, etc.) and constant babysitting for Ortho/NSGY...just not worth it, IMHO. Not even the occasional ER thoracotomy or trauma ex-lap/open belly/silo/damage control can make up for it.

My $0.02.

 

[FDNewbie]

Ouch...sounds like you guys have really had your fair share of experiences haha. I guess I got 2.5 yrs go to to see if it's soured me or not...but I'm def. going in very eager & excited!

Also keep in mind most Surg. programs only have about 6 months or so of trauma throughout the entire 5 year program; I did 4 months back to back last year, and am STILL gung-go. So that's got me a lil confident...

 

[Winged Scapula]

Ouch...sounds like you guys have really had your fair share of experiences haha. I guess I got 2.5 yrs go to to see if it's soured me or not...but I'm def. going in very eager & excited!

Also keep in mind most Surg. programs only have about 6 months or so of trauma throughout the entire 5 year program; I did 4 months back to back last year, and am STILL gung-go. So that's got me a lil confident...

Heh...I did a year of Trauma service duty, plus Trauma call for 5 years. Let's not include the SICU rotations in which you cared for the Trauma patients but that adds several more months.

The heavy emphasis on Trauma and CC was fodder for conversation by the community attendings we worked with (who always kept trying to dissuade us from actually managing the ICU patients).

 

[dienekes88]

Ouch...sounds like you guys have really had your fair share of experiences haha. I guess I got 2.5 yrs go to to see if it's soured me or not...but I'm def. going in very eager & excited!

Also keep in mind most Surg. programs only have about 6 months or so of trauma throughout the entire 5 year program; I did 4 months back to back last year, and am STILL gung-go. So that's got me a lil confident...

but but but... you're "wanting to retire"...

 

[FDNewbie]

Heh...I did a year of Trauma service duty, plus Trauma call for 5 years. Let's not include the SICU rotations in which you cared for the Trauma patients but that adds several more months.

The heavy emphasis on Trauma and CC was fodder for conversation by the community attendings we worked with (who always kept trying to dissuade us from actually managing the ICU patients).

Geez...where on earth did you do a YEAR of Trauma at as a resident?! That's a lot of months, not including the ICU months...

but but but... you're "wanting to retire"...

LOL yea lets not get into that man haha

 

[Celiac Plexus]

Geez...where on earth did you do a YEAR of Trauma at as a resident?! That's a lot of months, not including the ICU months...

I'd venture to say that residents at most academic, level I trauma centers spend about that much time on trauma. I have spent nearly a year on trauma surgery as well, and I will have taken 3 years of trauma call by the time I finish general surgery residency.

 

[Blade28]

Ouch...sounds like you guys have really had your fair share of experiences haha. I guess I got 2.5 yrs go to to see if it's soured me or not...but I'm def. going in very eager & excited!

Also keep in mind most Surg. programs only have about 6 months or so of trauma throughout the entire 5 year program; I did 4 months back to back last year, and am STILL gung-go. So that's got me a lil confident...

(1) Why, what happens in 2.5 years?

(2) Where did you get the "6 months of trauma" figure from?