Doing well on surgery electives

[726637 11]

Hello!

I'm looking for advice on what makes an excellent clerk during surgical electives. Is there anything to help make you stand out? Anything you would suggest to do differently as an elective student rather than a CC3 on a core rotation?

 

[#YOLO 165]

dont get in the way. dont be too keen

[#YOLO 165]

also helps if u fit certain demographic types for certain schools

[Edict 674]

I would say an excellent clerk is hardworking, dedicated, listens, follows direction, puts patients and team first, has good situational awareness both in the OR but also outside and is keen. As an elective clerk, be willing to take some crap thrown on you, people like clerks who can take a hit and get right back up. A lack of knowledge is a detractor, but honestly any knowledge that demonstrates you are genuinely interested in this specialty/thought about it is definitely a check in that department, you don't need to be a genius. 

Above all i think what residents and staff are looking for is someone who demonstrates they are genuinely interested in the specialty, someone who people think can survive the "rough times" during residency and someone who puts the team and others first. 

Don't buy into "demographics" stereotypes. Certainly look for a school that you really feel you belong to, but don't give up just because people tell you stereotypes of certain programs that you don't feel fit you. See for yourself when you go there, definitely let your gut instinct guide you. 

[NLengr 782]

14 hours ago, Edict said:

I would say an excellent clerk is hardworking, dedicated, listens, follows direction, puts patients and team first, has good situational awareness both in the OR but also outside and is keen. As an elective clerk, be willing to take some crap thrown on you, people like clerks who can take a hit and get right back up. A lack of knowledge is a detractor, but honestly any knowledge that demonstrates you are genuinely interested in this specialty/thought about it is definitely a check in that department, you don't need to be a genius. 

Above all i think what residents and staff are looking for is someone who demonstrates they are genuinely interested in the specialty, someone who people think can survive the "rough times" during residency and someone who puts the team and others first. 

Don't buy into "demographics" stereotypes. Certainly look for a school that you really feel you belong to, but don't give up just because people tell you stereotypes of certain programs that you don't feel fit you. See for yourself when you go there, definitely let your gut instinct guide you. 

Work harder than hard. Offer to see consults that come up. Offer to stay late if the residents are busy and also working late. At the same time don't be too keen. If the residents tell to go home or that you don't need to see a consult, they mean it. You can ask if they are sure, but don't force yourself into doing work if they tell you not to.

Offer to write notes on rounds. Offer to fill out paperwork. 

When you see a consult and you go to present it to the residents or staff, have a plan for what you want to do, even if you aren't 100% sure its correct. Nothing is worse than when you ask a clerk what they want to do with a patient and the clerk gives you a blank look and shrug. 

Read around the major presentations you see so you have some knowledge to fall back on (for example on gen surg, make sure you read up on appendicitis, on Ortho: hip #, on urology: stones). A little extra knowledge from a clerk is very impressive sometimes.

Pay attention in the OR. Don't daydream and be out in space. Ask an occasional question sometimes (ex. Why do you close the fascia with that type suture?). 

Don't be a douchebag. Hahaha 

[LittleDaisy 288]

3 hours ago, NLengr said:

Work harder than hard. Offer to see consults that come up. Offer to stay late if the residents are busy and also working late. At the same time don't be too keen. If the residents tell to go home or that you don't need to see a consult, they mean it. You can ask if they are sure, but don't force yourself into doing work if they tell you not to.

Offer to write notes on rounds. Offer to fill out paperwork. 

When you see a consult and you go to present it to the residents or staff, have a plan for what you want to do, even if you aren't 100% sure its correct. Nothing is worse than when you ask a clerk what they want to do with a patient and the clerk gives you a blank look and shrug. 

Read around the major presentations you see so you have some knowledge to fall back on (for example on gen surg, make sure you read up on appendicitis, on Ortho: hip #, on urology: stones). A little extra knowledge from a clerk is very impressive sometimes.

Pay attention in the OR. Don't daydream and be out in space. Ask an occasional question sometimes (ex. Why do you close the fascia with that type suture?). 

Don't be a douchebag. Hahaha 

I would say only ask questions in the OR, if the operating surgeon feels like chatting or asks your question first. Don't ask questions if the staff surgeon is concentrated or in a bad mood, you will be yelled at.  When your resident is closing up, ask him or her if you could contribute as well (very often, the staff has already left the room).

[Edict 674]

17 minutes ago, LittleDaisy said:

I would say only ask questions in the OR, if the operating surgeon feels like chatting or asks your question first. Don't ask questions if the staff surgeon is concentrated or in a bad mood, you will be yelled at.  When your resident is closing up, ask him or her if you could contribute as well (very often, the staff has already left the room).

Yes, this. 

Its better to be a fly on the wall when you are new to the OR. You want to know the surgeon's personality first and see the OR dynamics. The surgeon's personality determines the entire atmosphere of the OR. A chatty surgeon might be happy to answer questions in the OR whereas a more serious surgeon may want complete silence. It depends on the case as well, a complex case or a crucial part of the procedure should be done with 100% concentration.

Don't forget its okay to make a mistake, asking a question and getting yelled at does not mean the surgeon is going to give you a bad eval. You just don't want to do it repeatedly. 

[NLengr 782]

5 hours ago, Edict said:

Yes, this. 

Its better to be a fly on the wall when you are new to the OR. You want to know the surgeon's personality first and see the OR dynamics. The surgeon's personality determines the entire atmosphere of the OR. A chatty surgeon might be happy to answer questions in the OR whereas a more serious surgeon may want complete silence. It depends on the case as well, a complex case or a crucial part of the procedure should be done with 100% concentration.

Don't forget its okay to make a mistake, asking a question and getting yelled at does not mean the surgeon is going to give you a bad eval. You just don't want to do it repeatedly. 

Yeah I should have specified that. Don't ask questions when bad shit is happening or the surgeon is concentrating on something. Also some people just hate talking during the OR. Make sure you judge when is a good time to ask questions.

I'm the type of surgeon who doesn't mind questions. But some people aren't like me.

[NLengr 782]

5 hours ago, LittleDaisy said:

 Don't ask questions if the staff surgeon is concentrated or in a bad mood, you will be yelled at.

If you are a staff surgeon (or staff anything) and you are yelling at med students, you are a pathetic loser. I feel bad that you have to push around the students to make up for your small penis. Just saying.....

[Arztin 608]

On 9/22/2018 at 8:57 PM, NLengr said:

If you are a staff surgeon (or staff anything) and you are yelling at med students, you are a pathetic loser. I feel bad that you have to push around the students to make up for your small penis. Just saying.....

Seriously yeah.... It's truly a loser behavior to belittle more junior trainees.

Talking about which, I just got yelled at by a staff recently for no good reason. That staff is known to have wild mood swings changing by the fraction of a second, so I didn't really care. As a junior resident, I still get amazed every now and then by some people in the medical profession (negatively speaking in this case).

[LittleDaisy 288]

7 minutes ago, Arztin said:

Seriously yeah.... It's truly a loser behavior to belittle more junior trainees.

Talking about which, I just got yelled at by a staff recently for no good reason. That staff is known to have wild mood swings changing by the fraction of a second, so I didn't really care. As a junior resident, I still get amazed every now and then by some people in the medical profession (negatively speaking in this case).

I had the same experience, but was yelled by the NPs in surgery. I didn't take it personally, but I could see how surviving in an high-stress environment with heavy workload could change one's personality. 

[NLengr 782]

1 hour ago, LittleDaisy said:

I had the same experience, but was yelled by the NPs in surgery. I didn't take it personally, but I could see how surviving in an high-stress environment with heavy workload could change one's personality. 

Are you a resident or a med student? I can't imagine an NP ever yelling at a resident. Med students on the other hand....

Either way, medicine has way to many self important moody dickheads. It's worse in academic centers in my experience. It would never be tolerated in most other industries. 

[LittleDaisy 288]

1 minute ago, NLengr said:

Are you a resident or a med student? I can't imagine an NP ever yelling at a resident. Med students on the other hand....

Either way, medicine has way to many self important moody dickheads. It's worse in academic centers in my experience. It would never be tolerated in most other industries. 

Resident. Yeap it did happen. I am off-service for general surgery, and the NP in question was fairly senior. I didn't take it personally. They are definitely even worse with the medical students.

It's very difficult to address intimidation in clerkship & residency, as you know that these individuals are evaluating you and are above you, which is unfortunate. 

[NLengr 782]

9 hours ago, LittleDaisy said:

Resident. Yeap it did happen. I am off-service for general surgery, and the NP in question was fairly senior. I didn't take it personally. They are definitely even worse with the medical students.

It's very difficult to address intimidation in clerkship & residency, as you know that these individuals are evaluating you and are above you, which is unfortunate. 

I'm really surprised. Usually the NPs play nice with residents.

It's impossible to address as an individual. If you complain to the university, they don't really care. They give you lip service but have no interest in really fixing the problem as they care more about academic staff than residents or med students. And if the staff finds out about the complaint you are at very high risk of retaliatory vindictive actions (by that staff or others) or being specifically targeted in the future. And that risks your future career. Unfortunately the safest thing overall in most situations is to shut your mouth and take the abuse so that you can finish residency and move on with your life.  

[Arztin 608]

43 minutes ago, NLengr said:

I'm really surprised. Usually the NPs play nice with residents.

It's impossible to address as an individual. If you complain to the university, they don't really care. They give you lip service but have no interest in really fixing the problem as they care more about academic staff than residents or med students. And if the staff finds out about the complaint you are at very high risk of retaliatory vindictice actions (by that staff or others) or being specifically targeted with in the future. And that risks your future career. Unfortunately the safest thing overall in most situations is to shut your mouth and take the abuse so that you can finish residency and move on with your life.  

Yup. Totally agreed. This part of medicine truly sucks.

[rmorelan 2,561]

On 9/22/2018 at 8:55 PM, NLengr said:

Yeah I should have specified that. Don't ask questions when bad shit is happening or the surgeon is concentrating on something. Also some people just hate talking during the OR. Make sure you judge when is a good time to ask questions.

I'm the type of surgeon who doesn't mind questions. But some people aren't like me.

I always arranged some sort of sign from the resident to help me know if this staff was good for that, or if this was a good time even for those staff that can be. No doctor really wants to be interrupted in the middle something requiring thought or skill (that goes for radiology as well ha). 

[Edict 674]

On 9/25/2018 at 9:40 PM, NLengr said:

Are you a resident or a med student? I can't imagine an NP ever yelling at a resident. Med students on the other hand....

Either way, medicine has way to many self important moody dickheads. It's worse in academic centers in my experience. It would never be tolerated in most other industries. 

The problem is that because of parallel hirearchies, people in the nursing hierarchy can get away with bad behaviour. I've seen RNs throw shade and sass on fellows. I've had this kind of thing happen to me as well as a resident. The vast majority of people are nice, its usually one or two people at most. I think one of the things you learn quite quickly is to not take it personally, if you give them 0 response and you don't let what they say affect you, it helps a lot. 

[FailureToThrive 37]

On 9/26/2018 at 2:02 PM, rmorelan said:

I always arranged some sort of sign from the resident to help me know if this staff was good for that, or if this was a good time even for those staff that can be. No doctor really wants to be interrupted in the middle something requiring thought or skill (that goes for radiology as well ha). 

How do you kindly ask a resident to give you a sign?

[yonas 3]

On 9/21/2018 at 7:56 PM, #YOLO said:

also helps if u fit certain demographic types for certain schools

what do you mean? any specifics?

[LittleDaisy 288]

On 9/25/2018 at 9:53 PM, NLengr said:

I'm really surprised. Usually the NPs play nice with residents.

It's impossible to address as an individual. If you complain to the university, they don't really care. They give you lip service but have no interest in really fixing the problem as they care more about academic staff than residents or med students. And if the staff finds out about the complaint you are at very high risk of retaliatory vindictive actions (by that staff or others) or being specifically targeted in the future. And that risks your future career. Unfortunately the safest thing overall in most situations is to shut your mouth and take the abuse so that you can finish residency and move on with your life.  

Yeah, it's very unfortunate to address intimidation and bullying in medical school by staff physicians, senior residents, NPs or allied health; as you know that they are evaluating you. The system is defaulted in a way, that even with interpersonal conflict and complaint, they end up evaluating you anyway. 1 bad ITER-----> CaRMS is in jeopardy, which you don't want to risk with current competitive matching system. 

Often, as a medical student, you have no power, and just pray that you get a decent evaluation and survive on a daily basis if you run into interpersonal conflict. When you do complain to the university, they often side with the staff physicians and criticize the learners for lacking insight and not willing to improve their deficiencies. That's why so many unprofessional staff physicians lacking teaching skills are still put at forefront of medical education, because the system of reporting them is so flawed and carries repercussion. 

As a resident, you do have a bit more power and control, but often, I find it easier just to shut my mouth and move on than to fight the system. What I find unfortunate, is not being able to report  or stand up for my medical students when they are being bullied by NPs or staff physicians.

I really do hope that the future medical education does change, and that we don't pass along our horrible experience to the future learners. 

[medigeek 82]

On 4/16/2019 at 1:35 PM, LittleDaisy said:

Yeah, it's very unfortunate to address intimidation and bullying in medical school by staff physicians, senior residents, NPs or allied health; as you know that they are evaluating you. The system is defaulted in a way, that even with interpersonal conflict and complaint, they end up evaluating you anyway. 1 bad ITER-----> CaRMS is in jeopardy, which you don't want to risk with current competitive matching system. 

Often, as a medical student, you have no power, and just pray that you get a decent evaluation and survive on a daily basis if you run into interpersonal conflict. When you do complain to the university, they often side with the staff physicians and criticize the learners for lacking insight and not willing to improve their deficiencies. That's why so many unprofessional staff physicians lacking teaching skills are still put at forefront of medical education, because the system of reporting them is so flawed and carries repercussion. 

As a resident, you do have a bit more power and control, but often, I find it easier just to shut my mouth and move on than to fight the system. What I find unfortunate, is not being able to report  or stand up for my medical students when they are being bullied by NPs or staff physicians.

I really do hope that the future medical education does change, and that we don't pass along our horrible experience to the future learners. 

What I find shocking is that an NP has any authority over you at all. Sad state of our medical system. Now we have PAs growing in numbers? Becoming Americanized day by day. Not sure why doctors don't take a stronger anti-midlevel stance before it gets out of control like down south. 

[JohnGrisham 1,698]

11 hours ago, medigeek said:

What I find shocking is that an NP has any authority over you at all. Sad state of our medical system. Now we have PAs growing in numbers? Becoming Americanized day by day. Not sure why doctors don't take a stronger anti-midlevel stance before it gets out of control like down south. 

Surgical staff love NPs. Have one person to manage all your post-op patients who need to stay in hospital for a few days for recovery. Its like having a really good R1 who just does ward duty and can manage most things on their own without bothering you.

[1D7 156]

12 hours ago, medigeek said:

What I find shocking is that an NP has any authority over you at all. Sad state of our medical system. Now we have PAs growing in numbers? Becoming Americanized day by day. Not sure why doctors don't take a stronger anti-midlevel stance before it gets out of control like down south. 

Well mid-levels proliferated in the first place because physicians in America realized they could make more money supervising PAs/NPs (see anesthesia, primary care) or delegating tasks to them (see surgery), rather than seeing patients themselves. They do make the services more efficient, so a mid-level functioning at the 'mid-level' is actually good for everyone.

It's mainly a negative when they push for autonomous practice, which frequently seems to be the case because their own schools/programs tell them that they receive equivalent or better training to doctors lol.

[medigeek 82]

9 hours ago, 1D7 said:

Well mid-levels proliferated in the first place because physicians in America realized they could make more money supervising PAs/NPs (see anesthesia, primary care) or delegating tasks to them (see surgery), rather than seeing patients themselves. They do make the services more efficient, so a mid-level functioning at the 'mid-level' is actually good for everyone.

It's mainly a negative when they push for autonomous practice, which frequently seems to be the case because their own schools/programs tell them that they receive equivalent or better training to doctors lol.

What you're saying is a bit outdated though. Right now they are in such insane supply that just through sheer numbers, they are displacing physicians are alarming rates. Yes, tons of sick patients given the aging and obese population so the market demand is there to keep physicians going but it's still awful to get displaced by an NP. We really need to wake up here and make sure things are kept under control.

Like why are doctors endorsing PAs and PA groups? Why support any midlevel group? And again the key factor is the numbers. Finding a way to keep their supply low is the most important thing. 

[1D7 156]

10 hours ago, medigeek said:

What you're saying is a bit outdated though. Right now they are in such insane supply that just through sheer numbers, they are displacing physicians are alarming rates. Yes, tons of sick patients given the aging and obese population so the market demand is there to keep physicians going but it's still awful to get displaced by an NP. We really need to wake up here and make sure things are kept under control.

As far as I know there are only a few cases of hospitals replacing their anesthesiologists/emerg docs with CNRAs/PAs. It's a few cases too many and it does appears to be on the rise, but outright displacement still isn't too common yet.

In America most hospitalists, anesthesiologists, and emerg docs have allowed themselves to become employees of large hospital systems and corporations so they have no real control over anything anyway.

Quote

Like why are doctors endorsing PAs and PA groups? Why support any midlevel group?

With increasing healthcare costs, there is also increasing pressure to increase efficiency and midlevels are a great way to do that. On the floor, there are plenty of patients with chronic dispo issues that residents/attendings don't really want to deal with. In clinic, having more warm bodies always helps. Basically having someone who can function at the level of a resident long-term is beneficial and makes teams more efficient. On a financial level, seeing more patients = more money for the attending.

Anyway it's not really an issue physicians can oppose; doctors are rarely a united group (see OMA). If hospitals want midlevels and there's a school churning them out, then they will eventually come. To oppose it would need docs to unite, take back hospital leadership/admin, lobby effectively... essentially things that are unlikely to happen, especially since the problem of displacement may never even happen in Canada.