Finishing PGY1 year in a university/tertiary center.
First thing - I love surgery, not a single doubt in my mind; still very happy with my decision to go into the field, but...
Feeling pretty frustrated with my education so far. I know a lot of the ranting to follow isn't unique to me or my program but I just wanted to hear other people's perspectives.
I feel like i am:
1) Not going to the OR enough...or at all
Barely scraped 100 cases logged this year and 50+ of those were colonoscopies/egds that I did 1/3 of before having the scope ripped away by an impatient GI attending. Of the other 50, 25 were minor in-office lumps and bumps. The other 25 were some big whacks that I got to watch the fellow/chief/attending do and maybe (if i'm lucky) throw a drain stitch or close some skin afterwards. I'm about to be a 2 and I haven't placed a chest tube, haven't placed an NG, haven't first assisted a hernia/appy/gallbladder.
2) Drowning in clinic BS
We go to clinic a lot at my program. I mean, most services have at least a half day of clinic everyday and interns are expected to see every patient and write the note. That means I'm in clinic 4 or 5 days of the week. This is on top of floor work and managing consults. Seriously, 75% of my job is writing clinic notes - attendings will rarely see patient by themselves. Actually getting taught anything is very hit or miss. I feel like a scribe most of the time, making sure that the visit is documented so the hospital can make money and the next poor intern on service at the follow up visit knows what the hell is going on. Part of me feels like this could be a blessing in disguise - clinic is great for seeing the natural history of disease, learning how to diagnose, decide who needs what, etc, etc...but should I be up all night finishing clinic notes instead of reading about, ya know, surgery? Or god forbid, scrubbing into a case more than once a week? The expectations from the ACGME is like 0.5 days a week not 5
3) Inpatient floor stuff isn't much different
Now that I think about it, all I do on the floor is write notes, field pages, and get told what to do. No teaching rounds. No presenting of my plan. No autonomy what so ever. I feel like a very competent 4th year medical student.
One more month to go of intern year and this is starting to really get to me. I'm scared that second year won't be much different. And what about beyond? When the hell do I actually get to do something other than write notes - getting my hands dirty was the whole reason I went into surgery in the first place.
Anybody else stuck being a scribe in surgery residency?
Are you at my general surgery program???
Long term readers and the more astute among us might recall that this is a topic I've previously posted on over the years......I
hated my general surgery program.....and in reflecting on my experiences I want to emphasize that I think the word hate gets thrown around so casually that it fails to deliver some of the intended impact. I don't hate that place the way kids hate vegetables or the way people hate tom brady and lebron.....I don't hate it the way people hate nickelback. I hate the place the way people hate child abuse, war and famine. The way Hunter S. Thompson hated Richard Nixon. I read his obituary of Nixon randomly while I was a chief resident in a book someone gave me, and the amount of smoking fury coming off the pages captured an anger I immediately identified with. For those of you who might be unfamiliar, he said Nixon's coffin should have been launched into an open sewer, or his body burned in a trash bin.....he said Nixon was so crooked he had to screw his pants on in the morning and was proud he beat on him in article after article because he was such a scumbag. He wrote this in an obituary, of a man who was once President, all in one booze fueled manic session while watching the funeral on TV! I mean jesus that's hate.......and I know exactly how he felt.
My intern year was eerily similar to this....for the record I did 2 cases....one where I held retractors and the other I kinda got to do but was basically screamed at continuously for two hours. Second year was the same just sub in the word "ICU" for floor and clinic and that was my first two years. I got to operate after that but I wouldn't go on to call it a great experience....it was a strange mix of a lot of watching or an almost negligent approach to "autonomy" followed immediately by watching while most staff displayed obvious annoyance, fear, disgust or apathy. If they did talk to you it was usually to gossip/complain about how much the other residents in your class sucked....guess who they talked about with your co-residents when you weren't there? It was common knowledge who put a trocar in wrong, didn't match into their choice of fellowship or failed the absite, etc....things I found profoundly unprofessional, and I like to tell yo momma jokes all day lest you think I'm some sort of tight ass.
To the OP I identify with you in more ways than one...its most striking how you and others in your position don't have any qualms about doing all this work. You're not actually upset by the volume of nonsense you have to deal with, its the lack of teaching you're upset about and rightfully so. It took me a couple of years to figure this out for myself so you're miles ahead of where I was, but the reason I hated my residency program so intensely had less to do with the volume of scut or the overall poor treatment....hell after 10 years of post graduate training I can't be defeated by anything. It had to do with the lack of mentorship, instruction and education.....the things we all expect in return for the service work. As interns we were scribes, as second years we were ICU triage operators. As chiefs we were schedulers, conflict resolution specialists, stapler loaders, harmonic/ligasure engineering, preppers/drapers, and incision closers. I hate the place because just like you I did my part....I showed up to clinic, I wrote those notes and answered those pages. In return I didn't get much in the way of mentorship or education. This one sided loyalty that many of us in residency display is a special sort of slavery, a system that was great for the master but not so much for the slave.
I sincerely hope with all my heart and for your sake that you're not where I was, and like the many experienced posters above have pointed out this is not terribly different from many intern experiences in surgery, unfortunately. Hopefully your next years will see an explosion in operative volume and your residency is just top heavy in that way, and that as you gain seniority your attendings will get to know you and take more of an interest in your education. Sometimes between the prelims and designated categorical residents going into other surgical specialties the entire intern class is a blur of faces and as you climb the ranks you become more of a distinct entity to the people in charge. A top heavy residency program cannot change because all the cases your chiefs didn't do on the way up they have to do now, you will benefit greatly from this system as a chief when you don't have to do any clinic lol
If that doesn't happen though here's what you do, and this can go for anyone who (like myself) didn't feel like they trained at a place that was setting them up to win:
1) find a mentor. Surgeons are bold skeptics, there is certainly someone around the shop who thinks the current system is lacking. These people may be few and far between but they exist, but they are almost certainly not at the top in positions of power. Look for younger attendings or people who may have trained in other places, and not indoctrinated into the current system. Don't even think about the PD or an assistant PD or someone like that, these are the people responsible for your current system and they put it in place for a reason despite whatever lip service they may pay to keep the ACGME survey up to snuff. Same goes for anyone who trained there and stayed on as staff.
2) plan to do a fellowship. Everyone does one anyway, if your program doesn't set you up to win you'll find one that does. Even more so in "different" fields, like cardiothoracic (my field), transplant or plastics where a lot of the general surgery skills you didn't get don't matter and none of them care about general surgery anyway. You don't have to be a good colon surgeon to do a kidney transplant, even if its still in the abdomen. If you want to be a general surgeon find a fellowship that allows you to specialize but still maintains some broad coverage, like an MIS, ICU or trauma fellowship where you still do a fair amount of bread and butter cases as a fellow with an attending backing you up. Alternatively do one of those transition to practice fellowships.
3) do a year or two of research somewhere else. Plug into a different system, get a new group of mentors/advocates that can help set you up to win.
4) Be strategic. If they're not going to teach you, you have to go above and beyond to learn how to operate. Practice at home everyday so that every stitch you get in the OR counts. Review every case you "do" to an obscene degree. Always (always always) do the right thing by the patients, beyond that you don't get an award for logging the most clinic hours or making your attendings lives even easier.....go watch a case for half an hour and show up 10 minutes late to clinic, tell the attending you had to handle something on the floor while they saw the first patient. Our conferences were lame so I would print out real articles and sit in the back and read them or skip entirely. Find a real jerk of an attending who people don't like operating with but lets you do more than the average...then find a lazy co-resident who likes to dump work. Offer to switch cases and get better while they have a grand time running the bovie between the clamps with the nice surgeon next door...they'll think they're winning. Take your vacations on the services where you don't get to do anything, schedule fellowship interviews during lame nonoperative rotations. Break with the accepted standards/norms at the risk of ruffling feathers...for example our chairman didn't let us do anything in the OR, didn't know our names and wouldn't write rec letters or make phone calls for anyone.......so as a chief I sent him the PGY2 and operated with a junior attending (who was awesome) instead because it was a better opportunity for me....it raised some eyebrows for sure but its not a hanging offense. If you have staff that won't teach or mentor you why waste time pleasing them.....you have nothing to gain and nothing to lose. Don't be afraid to advocate for yourself even if you catch some hell for it.....that chairman may have hated me....I don't care and neither should you.
Here's what you don't do:
1) switch programs. No one has ever switched into a better program in the same field. Guess what happens when you try to file that paperwork? You are now persona non grata, and you only thought it was bad before.
2) expect the ACGME to save you or change anything anyway when you file a formal complaint. Has anyone ever see this end well for anyone? Did you ever hear about how in the USSR political dissidents were sent to insane asylums to be re-educated? Some of those people were never seen again.....
3) make your opinions known. The people in charge know this is a scam, they're not oblivious to the fact that you're not getting a good experience. They sleep great at night, just like Bernie Madoff did all those years, and if you speak up......see number 1 and 2 above.
Hopefully it gets better, if not its only a few years and you can get someplace better. This was exactly my path, I went on to a fantastic fellowship where I have been treated extremely well. I've been basically seen as a colleague/friend from day one and advocated for more by my staff than I could have ever hoped...I'm going on to a faculty spot at a big fancy place next year but I'm very sad to leave where I am....my fellowship basically restored my faith in all training humanity. So there's light at the end of the tunnel....I always advise people not to do anything rash in a state of despair or anything. Despite all the anxiety things have a way of working themselves out.
