Residents: what do you think of MS3 surgery students?

[45408]

Compare that to my PEDS rotation, where I spent 45 minutes one morning frantically trying to track down a patient and his chart. He had mysteriously disappeared, but his name was still on the door and hadn't been discharged.

At morning rounds, the peds attending asked me about that particularly patient. I was ashamed to admit that I hadn't been able to see that patient that morning. At this point, the resident (whom I had been sitting next to all morning!) piped up and said, "Oh, urology came by and took him to the OR early this morning."

Well, thank you for taking your sweet time to share that trivial little bit of information with me! Yeah, that made me feel like a real member of the team! [Ugh, I hated that godforsaken rotation.]

Um, why didn't you just ask the resident where the patient was? Or the nurse? Or the HUC? Or look on the computer for room assignments?

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[smq123]

Um, why didn't you just ask the resident where the patient was? Or the nurse? Or the HUC? Or look on the computer for room assignments?

- Not all hospitals have good EMR systems that track which room patients are in. That particular hospital didn't.

- I DID mention that I didn't know where that patient went. The resident just shrugged her shoulders and went back to her work.

- The nurses were AWOL. Couldn't find one to save my life.

This was near the end of my third year. Trust me, I know the usual routes to finding a patient and can exhaust them on my own.

 

[Blade28]

Agreed...I've been in some small hospitals where the only way to locate a patient was to call the operator.

 

[CCLCMer]

Thanks to everyone who has been commenting on this thread. Both sides have given me something to think about. Now I have a somewhat different question for you surgery residents. What do you think about a med student doing a surgery AI even if they have no intention of going into surgery? This would be just to learn more about surgery. Up through the end of this year, Case has only been requiring us to do four weeks of inpatient surgery. Most people agree that isn't enough, and they are changing the rotations for next year. So the current MS3s will be the last people who only have four weeks of surgery, but even next year, I think they will only have six weeks.

Fortunately, I had a much better surgery experience than some of the other med students who have been posting here. My attending and fellow were both amazing, really into teaching and let me do a lot. I enjoyed going into the OR with them, even when they yelled at me for screwing up or not doing what I should have done. But I feel like by the time I was finally starting to "get it" where I understood what was expected of me and was part of the team, the rotation was over already. The thing is, we are required to do two AIs. One can be in anything we want, and the other has to be in surgery, medicine, or peds. It seems like I'm already getting plenty of medicine: one month each of outpatient, inpatient, geriatrics, and chronic care. But I know that my surgery education is a lot weaker than a lot of students at other schools, and I think it makes the most sense to do a surgery AI since it will probably be the last time I ever do surgery. My only hesitation is that I get the impression surgery AIs are mainly meant for people who plan to go into surgery, and that most people who don't plan to do surgery don't do a surgery AI! The course descriptions in the catalog even say that that these AIs are geared toward students who anticipate going into a surgical career.

If you agree with me that it makes sense to do the surgery AI anyway, the next question I have is what kind of surgery AI to do. My choices are general surgery, urology, ortho, ENT, neurosurgery, or endocrine surgery. I was on the colorectal surgery team for my surgery rotation, so I was thinking maybe I should do neurosurgery since I have no experience with that. But I wonder if I should do general surgery instead since I didn't see a lot of those bread and butter kinds of things. Plus it might be the most useful in terms of the educational value, especially since I don't know what I want to go into yet.

 

[elr1983]

Thanks to everyone who has been commenting on this thread. Both sides have given me something to think about. Now I have a somewhat different question for you surgery residents. What do you think about a med student doing a surgery AI even if they have no intention of going into surgery? This would be just to learn more about surgery. Up through the end of this year, Case has only been requiring us to do four weeks of inpatient surgery. Most people agree that isn't enough, and they are changing the rotations for next year. So the current MS3s will be the last people who only have four weeks of surgery, but even next year, I think they will only have six weeks.

Fortunately, I had a much better surgery experience than some of the other med students who have been posting here. My attending and fellow were both amazing, really into teaching and let me do a lot. I enjoyed going into the OR with them, even when they yelled at me for screwing up or not doing what I should have done. But I feel like by the time I was finally starting to "get it" where I understood what was expected of me and was part of the team, the rotation was over already. The thing is, we are required to do two AIs. One can be in anything we want, and the other has to be in surgery, medicine, or peds. It seems like I'm already getting plenty of medicine: one month each of outpatient, inpatient, geriatrics, and chronic care. But I know that my surgery education is a lot weaker than a lot of students at other schools, and I think it makes the most sense to do a surgery AI since it will probably be the last time I ever do surgery. My only hesitation is that I get the impression surgery AIs are mainly meant for people who plan to go into surgery, and that most people who don't plan to do surgery don't do a surgery AI! The course descriptions in the catalog even say that that these AIs are geared toward students who anticipate going into a surgical career.

If you agree with me that it makes sense to do the surgery AI anyway, the next question I have is what kind of surgery AI to do. My choices are general surgery, urology, ortho, ENT, neurosurgery, or endocrine surgery. I was on the colorectal surgery team for my surgery rotation, so I was thinking maybe I should do neurosurgery since I have no experience with that. But I wonder if I should do general surgery instead since I didn't see a lot of those bread and butter kinds of things. Plus it might be the most useful in terms of the educational value, especially since I don't know what I want to go into yet.

I'm just a 4th year student, but I actually did a peds surgery AI earlier this year b/c I thought it would help me in peds residency. I think I got a lot out of it, especially towards the end of the rotation when it became clear I wasn't doing surgery. I think at first, I was nervous, like you are, about doing a surgery AI as a non-surgery student, especially after my third year experience, but it ended up working out OK. (Other than the few general surgery residents over there who wouldn't let me into the call rooms, but that's another story...) As far as general surgery versus neuro or other specialty, I'm sure there are things to be learned from anything, but as you point out, general surgery may be more broadly applicable than some other things. On the other hand, unless you decide on doing surgery, you may never have another chance to see neuro, urology, etc, so it could be cool to have that experience as well. So sorry,can't really help you out there....but yea, I think it's worth doing, if you think you have the energy.

 

[Plastikos]

I think a lot has to do with the schools, the culture, and who knows. My surgery rotation was like the OP, i had 2 ICU pts and 2-3 floor pts, went to as much surgery as possible, and was ready to be pimped at all times. I enjoyed the faculty/residents, never a problem. Now it turns out this is a rough rotation, maybe even malignantish surgery program. I loved it though.

In residency, its hard to know where students are, they look offended and shocked when questions are asked, nothing is asked of them, and a grotesque percentage recieve A's. Some that recieve B's would have been at the deans office and in danger of failing school as a whole.

I have gone in and out of giving up on/avoiding them, trying to see if i can pique some interest in the medical field in general, but who knows. Here i feel like they are under the impression they are still in class and "school". Where as i felt we were part of the team with laid in stone duties and it was more work like in preparation for being a dr. It wasnt just me, the rads/derm/fam pract, all seem to have had a good attitude compared to the student here that says they want to do surgery but cannot be found on call.

I think it just comes down to culture, and here they are coddled.

 

[Dr. V]

Yes, I think it would be a good idea for you to do an AI in Surgery.

I am a Surgery resident and did an AI in Medicine, not because I enjoy medicine, quite contrary medicine rounds are painful for me. I did it because I knew it would help me be a better doctor and med school is where you get the experience in other fields.

Not only that, but more Surgery may help the surgeons wherever you end up because maybe you won't be the one consulting for zits, asymptomatic gallstones, constipation etc etc etc that is so common now days.

 

[njbmd]

I did AIs in Geriatrics, Cardiothoracic Anesthesia,Neurology, Gastroenterology and Radiology because I wanted to be a better general surgery resident. If you don't have a NEED for audition rotations, then choosing AIs based on getting more experience in disciplines that you are not planning to enter makes sense. I haven't regretted my decisions. Also, when interview time comes in, it doesn't look good to be absent from an audition rotation when you are trying to impress the program. It was far better to be absent from something that wasn't as crucial to matching.

 

[Blade28]

Of my MS-IV electives, I also chose some non-surgery ones to round out my medical education: Nephrology, Radiology, Pathology.

 

[SocialistMD]

I couldn't agree more with njbmd and Blade; I only did two surgical rotations during my fourth year (AI and an away rotation). The rest were medical subspecialties (cardiology, pulmonology) or things that would make me a more well-rounded physician (radiology). The nice thing about fourth year rotations outside of your chosen specialty is that they are very low stress and the amount you learn is much more because they are not service-based (like 3rd year ward rotations at my school were) and you aren't trying to impress anyone for a good letter.

 

[radslooking]

i did a more medical residency, and I did a lot of surgical rotations my fourth year. for anyone, I'd recommend doing whatever you won't be doing during your residency. that's the last time you'll ever get exposure to them again, and as socialist says, they are usually low stress because people know you aren't going into them.

 

[-Goose-]

As a third year planning on entering a surgical subspecialty, I'd like to hear the resident's perspective on what it means for an M3 to be excellent. I'm about to start my surgery rotation at a program that is known for being tough on students and really want to do well on the rotation.


Any tips/pointers would be greatly appreciated.

 

[smq123]

As a third year planning on entering a surgical subspecialty, I'd like to hear the resident's perspective on what it means for an M3 to be excellent. I'm about to start my surgery rotation at a program that is known for being tough on students and really want to do well on the rotation.

Any tips/pointers would be greatly appreciated.

Well, for starters, if it's a place that is "known" for being tough on students, I can tell you that the #1 rule is probably going to be: "Don't complain."

Don't complain, and don't ask to get sent home, unless you're so sick that they send you home. I know that sounds harsh, but that's probably going to be the way things will work there. Don't remind them that you were on call the night before either. That may not go over well.

Basically, once a resident has shown you how to do something, do it on your own from then on - don't wait to be prompted. The biggest complaint that I hear from residents is that med students tend to sit on a chair, like a bump on a log, waiting to be told what to do. In some ways, it's not fair to expect them to know exactly what to do if this is their first time in the OR, but once a resident has shown you how to do something, it's expected that you'll do it from then on.

Knowing when to be quiet is great. While being friendly is fine, if there is blood spurting everywhere, now is NOT the time to ask the scrub nurse how her weekend was. Pinching off the suction when pathology calls down to give their opinion on the frozen section is also welcome.

Ask other students what the culture of that rotation is. Some places get their students in the OR quickly, and expect even the MS3s to tie one-handed knots. Other places expect the students to help run the floor, and don't really care if you're good at suturing or not.

This thread might help: http://forums.studentdoctor.net/showthread.php?p=6142894#post6142894 (...which brings me to my last tip, which is "look things up for yourself." )

 

[JeffLebowski]

Well, for starters, if it's a place that is "known" for being tough on students, I can tell you that the #1 rule is probably going to be: "Don't complain."

Don't complain, and don't ask to get sent home, unless you're so sick that they send you home. I know that sounds harsh, but that's probably going to be the way things will work there. Don't remind them that you were on call the night before either. That may not go over well.

Basically, once a resident has shown you how to do something, do it on your own from then on - don't wait to be prompted. The biggest complaint that I hear from residents is that med students tend to sit on a chair, like a bump on a log, waiting to be told what to do. In some ways, it's not fair to expect them to know exactly what to do if this is their first time in the OR, but once a resident has shown you how to do something, it's expected that you'll do it from then on.

Knowing when to be quiet is great. While being friendly is fine, if there is blood spurting everywhere, now is NOT the time to ask the scrub nurse how her weekend was. Pinching off the suction when pathology calls down to give their opinion on the frozen section is also welcome.

Ask other students what the culture of that rotation is. Some places get their students in the OR quickly, and expect even the MS3s to tie one-handed knots. Other places expect the students to help run the floor, and don't really care if you're good at suturing or not.

This thread might help: http://forums.studentdoctor.net/showthread.php?p=6142894#post6142894 (...which brings me to my last tip, which is "look things up for yourself." )

Good advice (though like smq I'm a medical student, not a resident as the OP proposed). My own list would include:
1) Don't complain
2) Don't even hesitate to volunteer to do something if a resident/attending throws it out there. You can polish it up with anti-gunner repellent with "unless anyone else wants a crack at it" or something afterwards, but it looks bad if there's a deafening silence after a resident asks "can someone see the new consult in the ER" and someone finally uncomfortably submits. Chances are you'll be asked to do it anyway or offer after an awkward silence, if you're going to do something do it well and show some enthusiasm.
3) Be a normal person. This doesn't mean being the same jackass you are at home, it just means be friendly, somewhat humble, reliable, and relax a little when you're talking to people. Use your social grace. If you don't have any, fake it.
4) Get a good system in place for keeping track of your patients. At first you should go overkill, then pare it down as you develop an effective system. But you should know your patients well.
5) It's a challenge, but keep your notes as succinct as possible. People with the shortest notes get the most positive feedback about their notes. Being comprehensive and thorough isn't as valuable as being to the point and focused in surgery.
6) Be a team player and work hard. Try not to worry so much about what other people are doing. Offer to help your teammates, offer to share procedures/cool stuff, and be a good person even when others aren't. Believe me, integrity counts for a helluva lot more than gunning in your evals. That said, still make a good impression of being interested and involved by getting face time with your residents/attendings whenever you can.
7) Show some compassion now and then. I mean that's why you went to med school, and in theory you are a compassionate person. In surgery, it tends to be dampened out of you as you rush through prerounds, rounds, morning report, OR cases, floor work, consults, etc. But your patients are for the most part scared and nervous and could use a kind smile and a laugh or even their hand held as they go under or wait in pre-op.
8) Take every opportunity you are given to show yourself to be reliable and knock it out of the park.

 

[-Goose-]

This thread might help: http://forums.studentdoctor.net/showthread.php?p=6142894#post6142894 (...which brings me to my last tip, which is "look things up for yourself." )

Hahaha. Point taken.

Thanks for the advice.

 

[opr8n]

As a third year planning on entering a surgical subspecialty, I'd like to hear the resident's perspective on what it means for an M3 to be excellent. I'm about to start my surgery rotation at a program that is known for being tough on students and really want to do well on the rotation.


Any tips/pointers would be greatly appreciated.

1. accept that you life is not your own for 8 weeks
2. Suck it up no matter how tired you are
3. Ask LOTS of questions (but not ones that make you looks stupid)
4. READ ALOT
5. If offered the "option" to take call, do it, and do it with a resident that is interested in teaching if possible (imust preface this whole statement on the fatc that some schools dont even require the students to take call like i did when I was am ms3)
6. Scrub as many casses as you possibly can

 

[SocialistMD]

Keep your multiple coat pockets stocked with dressing change supplies for the morning rounds. When you are done with a patient, go to the next room and begin taking down the dressing. This makes the team move more efficiently and impresses your residents.

 

[SouthernSurgeon]

I came in to round at 4:30-5 before the interns
They come in at 6 when i now come in

I used to write 4-6 full notes in the am before the intern got there
They are lucky to get one written

I was at every OR case I could be at
I dont see somew of them ever show up in the or

I had to be on call q3 for 8 weeks and didnt go home the next day till 6pm sometimes
They take "short call" till 10pm, only four times in 8 weeks

Do the students meet their school's expectations? Your complaint appears to be with the med school, not the students

I was expected to know every patient on the list
They know no one, not even the people they round on

I would guess that when you were an MS3, your residents might have assessed your level of familiarity with the census a bit differently. I usually THINK I know every patient, but then my residents always seem to "magically" know more. You are in a much different place and have a much different perspective now.

I read every night for atleast an hour
They dont know anything, do they read?

Do you know how much they read? Have you talked to them about it? Maybe this would be a good opportunity to be a teacher, and point them in the right direction.