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I just did a rotation in a core specialty (surgical), and felt like I was just there to do the work of the team, and get the job done. I learned literally nothing, and worked easily 50-60 hours a week. To top it all off, my school has shelf exams, and I failed by one mark. I'm pretty angry - not only were we not taught the things relevant on the exam during the rotation, we grinded out 50-60 hours (some weeks were night shifts) and still learned nothing.

Is med school just unpaid labour?

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While your situation is unfortunate, I think your expectation of clerkship are not in line with reality. Your rotation will never teach you what you need to know to pass the NBME, you need to study on your own after your work day. Surgical rotations are very service based, you will learn the bread and butter clinical presentations by being part of the team. The true medical knowledge will come from self studying. This is true of any level of training, you cannot expect people to teach you everything you need to know. If your surgical weeks were only 50-60 hours, your rotation is pretty light for a surgical rotation and you should have time to read around cases and study.

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11 minutes ago, medmedmed132 said:

Is med school just unpaid labour?

It's worse than that...it's paid labour by YOU! You pay AND do the labour!

At least that's how I felt things were when I was in medical school...Surgery is tough, especially if you're not interested in it/don't have great teachers/residents/attendings to make your rotation fun. Many times I felt that I wasn't learning a lot or anything too. The shelf exams are also BS, especially if they make you still do the US ones with different units and all that crap. 

That being said, you definitely do learn things even if it means being able to write notes and round on patients. What I felt on surgery is that you really had to study on your own to pass the shelf exams. I don't really have a lot of advice, but I will say that if you're in 3rd year (which is my assumption), you've had a tough run in clerkship. Usually at this point in time is when I noticed a lot of my fellow clerks begin to burn out, because of the long hours and the winter and all that. Just know that you're not alone and there are always people that you can reach out to, to chat with. 

I hope you pass the shelf on your next attempt!

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I agree with you, medmedmed132. It's a patronizing waste of time how some staff/rotations treat you. I've sat in the OR watching 1-4 hour surgeries with zero acknowledgment by the staff. I can't ask questions because he's/she's busy teaching the resident/fellow, and besides, I don't care for surgery so I don't have many questions to ask. Some will respond that you need to "show initiative," but that's the typical mindset that the system is always right and we are always wrong. Showing initiative doesn't work when you have staff that don't care to teach you and either give you a few words when answering your questions or just tell you that you should read about it when you bring up a question. I have spent 10-hour shifts just following staff around and they never acknowledged me. Like skyuppercutt said, it's even worse when you consider that you're paying for this.

Learning about bread and butter clinical presentations does happen in any rotation, I agree, but it's extremely inefficient to learn it through service-based rotations like surgery. There is no need to watch hours long surgeries to "understand" a case better. I could learn much more efficiently at home or in services that are actually relevant to my career goals. Same goes for the practical skills of learning to write notes or prescriptions. After a few dictations in ortho, I realized that all I'm doing is dictating 25% of the staff's appointments for the day and not learning anything myself (because I was seeing the same presentations all day).

So anyway, I sympathize with you. I just keep reminding myself that if I put up with this, it'll be another few years and I'll be making 200k+ in a job that's meaningful and impactful. I've also stopped being 200% polite/respectful/deferential to staff when I realize that they're not going to be adding value to my learning (because they don't care to teach). I'll still be professional, but I don't follow them around and when there's downtime, I just ask them if I can study on my phone and they're fine with it. I also sometimes say no to requests if they say that it's my choice (e.g., I've said I don't want to scrub in for a c-section because I've already seen it a few times). This hasn't affected my evaluations. Part of clerkship, I think, is learning how to act like an adult in a workplace, and if you do that correctly, I think you're unassailable for making time for your own learning.

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35 minutes ago, gogogo said:

So anyway, I sympathize with you. I just keep reminding myself that if I put up with this, it'll be another few years and I'll be making 200k+ in a job that's meaningful and impactful. I've also stopped being 200% polite/respectful/deferential to staff when I realize that they're not going to be adding value to my learning (because they don't care to teach). I'll still be professional, but I don't follow them around and when there's downtime, I just ask them if I can study on my phone and they're fine with it. I also sometimes say no to requests if they say that it's my choice (e.g., I've said I don't want to scrub in for a c-section because I've already seen it a few times). This hasn't affected my evaluations. Part of clerkship, I think, is learning how to act like an adult in a workplace, and if you do that correctly, I think you're unassailable for making time for your own learning.

100%

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6 hours ago, Aetherus said:

While your situation is unfortunate, I think your expectation of clerkship are not in line with reality. Your rotation will never teach you what you need to know to pass the NBME, you need to study on your own after your work day. Surgical rotations are very service based, you will learn the bread and butter clinical presentations by being part of the team. The true medical knowledge will come from self studying. This is true of any level of training, you cannot expect people to teach you everything you need to know. If your surgical weeks were only 50-60 hours, your rotation is pretty light for a surgical rotation and you should have time to read around cases and study.

This is the best answer.

That said, don't you have academic days during your rotations? Generally those are meant to provide some embedded teaching / rotation specific medical knowledge baseline. At least when I was in medical school this was usually just enough to get a pass but certainly needed some self-study reading around topics you didn't come across on rotation.

Surgical rotations often are bread/butter and just service unfortunately. For those with minimal interest in the field, it is often not the best use of your training time 4-8 weeks on service.  Take initiative to try and get things out of rounding/ward time. And try to get out of standing around in the OR if surgery isn't your thing, and go learn from patients on the ward for post-operative mgmt etc. At least when you're a resident on an off-service surgical rotation, you'll be in a position to say "i'm not interested in being in the OR, I will go deal with ward patients".  As a medical student, smile, nod along, keep healthy with sleep/food, and read around pertinent knowledge for exams..then move on.

 

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6 hours ago, Aetherus said:

While your situation is unfortunate, I think your expectation of clerkship are not in line with reality. Your rotation will never teach you what you need to know to pass the NBME, you need to study on your own after your work day. Surgical rotations are very service based, you will learn the bread and butter clinical presentations by being part of the team. The true medical knowledge will come from self studying. This is true of any level of training, you cannot expect people to teach you everything you need to know. If your surgical weeks were only 50-60 hours, your rotation is pretty light for a surgical rotation and you should have time to read around cases and study.

I agree. Waiting for people to ‘teach you’ is not a great way to learn, and will never cover all the things you need to know. And many of those things you will just start to learn in clerkship, and will solidify over and over again. 

4 hours ago, gogogo said:

I'll still be professional, but I don't follow them around and when there's downtime, I just ask them if I can study on my phone and they're fine with it. I also sometimes say no to requests if they say that it's my choice (e.g., I've said I don't want to scrub in for a c-section because I've already seen it a few times). This hasn't affected my evaluations. Part of clerkship, I think, is learning how to act like an adult in a workplace, and if you do that correctly, I think you're unassailable for making time for your own learning.

I agree with this as well. Learning in clerkship is all about making the rotation work for you. Although admittedly that gets easier the more experience you have. Early in clerkship, and on the much more hierarchical rotations, it can be harder to do.

I had the fortune of doing my core clerkship in a smaller center, so I got used to being self-directed. E.g. in surgery when there were residents on and I didn’t feel like watching or didn’t want to assist (especially after the 3rd, 4th, 5th chole or whatever) I would go start consults or round on ward patients or, if there were no other learners, hop over to the anesthesiologist and ask if I could do the intubation and work with them. Now being back in the city for electives I find that taking initiative to do things I’m interested in (and asking for forgiveness later if needed) usually flies fine. If I want to do something else, I just ask (politely) - the worst the attending can do is say no. I also make work for myself that I actually want to do / will help me learn something instead of waiting for people to give me scut. E.g., I save up tasks and action items I want to get done for the afternoon - like reading around a case, following up with radiology, calling family, etc - and then when theres down time, or when someone else is looking for someone to offload some scutwork, or we are endlessly rounding on everyone else’s patients and it’s the 5th copd patient of the week, I just excuse myself to go get my own stuff done. 

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All of medical education is a tug of war between learning and exploitation that synthesizes into a steady deterioration of everything, punctuated by replenishments that become fewer and further between. And that is not okay, but it is not the hill you want to die on. Expect nothing from the system and look at the daily work in terms of its utility - will it help you match? Is it actually good learning? At rare times it actually is. And sometimes you may want to show initiative to make good impressions even if it isn't. But if you decide it is truly useless, do not hesitate to claw back as much time and energy as you can from the system and put it to your own use. Take frequent breaks, refuse to do procedures, call in sick within the limits afforded by your school. Bear in mind the potential consequences of doing such things and balance those risks with the benefits of having more free time. Play the tug of war right, and you can get through the hoops with less burnout. 

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As a resident at a school with NBME for the med students on our rotation, we try to optimize your learning for both clinical and NBME learning. We have gone through it ourselves, so for the first half we try to teach the med students the important clinical stuff to do well on the wards, practical medicine, etc. and towards the second half I try to cover the high yield NBME topics that you are unlikely to see during your rotation - for peds its the rare genetic disorders for some reason.

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Yeah unfortunately your experience is not unique. NBME exams is a whole different animal, you gotta study from high yield, USMLE style books like First Aid for Surgery to know the stuff.

It'll happen in residency too. If you are off service resident, sometimes you'll just be assigned to some tasks like floor issues or clinics where you don't really get to learn or do much except dictate notes. It's all dependent on how much you wanna get out of it, sometimes it takes a lot of effort just to get a chance to learn something, do something or see something. If you wanna coast, well that's up to you.

It'll happen on service sometimes, it's all dependent on the staff. Some staff will just expect you to magically know what to do or how to do something. Of course they've forgotten how to actually teach it, although they can do it from memory themselves. Worse is they tell you to just read a book haha! Like seriously I am gonna read this 500 page book tonight and tomorrow I'll know all the answers seriously?

And Royal College/American Board exams? that's another story. If you have good mentor they might provide you with some simulation questions of tips. A lot of staff are 10-20 years post their exam and knows nothing about the current exam. 

Just like NBME, for every standardized exam you gotta take the same approach. Your peers are your best resources. Get together with a few people, share books, videos, practice questions, whatever resource each can find. It's impossible that each person knows all the resources so group-sharing is essential to success. If you are the lone resident in a program, then you gotta rely on your seniors for this kinda stuff.

You gotta exploit flashcards and youtube and question banks online. Yeah some Q banks are expensive but especially for American Board/NBME/USMLE they really really help a lot, worth the $$. Youtube has so much good stuff, I learned so much stuff on there, some things the older staff didn't even know and they wonder where I acquired the knowledge haha. I used YT for royal college and it helped me so much. Trust me audio-visual is the best and most efficient method, it's scientifically proven.  

I converted all the useful YT videos into audio and listen to them on my way home or when I am doing chores or when out for walk. After listening 3-4 times the stuff really sink in. Then I discuss the stuff with co-resident, we quiz each other, correct each other, really super helpful for reinforcement. 

Never get shy for studying with another person, especially quizzing each other. Yeah at first it feels embarrassing when they ask you a question and you don't know the answer, but that's the best opportunity to ingrain the answer in your mind. You realize everyone has gaps in knowledge, so the more gaps you discover within yourself and within other people, the more you can feel confident you've covered all the relevant topics.

So yeah long rant, but in short, clinical work only has some overlap with exam material, so without discovering efficient, shrewd ways of studying, it's gonna be a struggle for the long road ahead.

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20 hours ago, medmedmed132 said:

I just did a rotation in a core specialty (surgical), and felt like I was just there to do the work of the team, and get the job done. I learned literally nothing, and worked easily 50-60 hours a week. To top it all off, my school has shelf exams, and I failed by one mark. I'm pretty angry - not only were we not taught the things relevant on the exam during the rotation, we grinded out 50-60 hours (some weeks were night shifts) and still learned nothing.

Is med school just unpaid labour?

I am so sorry. I had a similar experience in Gen Surgery, except my week was 80+ hours. Surgery is service-based rotation, and I don't think you are there to learn as much as do whatever you are told to do.. Now, to help you pass, I used the following:

- paul bolin - Gen surgery videos

- Osmosis - Gen surgery videos + all the other surgery videos

- case files

Got 85% on my shelf exam :) Not a 100% but a decent score for someone who hates surgery!

Other strategies I used to get time off during Surgery

- submitted a conference abstract --> got a free day off

- used a flex day

Now I got 2  days off during Gen Surgery to study before exam. 

The way medical education is structured is literally to exploit juniors unfortunately.. but just remember it is another hoop - it's probably the last time in your life you have to do surgery if you are not interested.  Some staff/residents really don't care about you at all - it's a very unfortunate system. Just remember when you are staff or resident to try and teach your junior something useful, instead of constantly expecting them to do all your work and not returning favour.. the worse thing in Gen Sx was that they were not even grateful that I was doing their work like in most other rotations... 

 

Good luck and reach out if you need anything :)

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I forgot to mention when it comes to teaching staff are often not the best, because they've forgotten the gauge for a medical student. For example one infamous surgeon failed a bunch of medical students some year back because he thought their knowledge were all poor. Like seriously you're comparing a board certified guy 15 years into practice to bunch of newbies 4 weeks into their first surgical experience. I bet if I ask that surgeon to do a psychiatry interview he'd probably fail too. A lot times it's more helpful to seek learning from residents who can relate more to your level of knowledge. For example if you are in clinic with a junior resident or off service resident, ask them questions instead. 

Reading around a case is often a good exercise say when you are relegated to the dictation room. For example if you have someone that had underwent an oncologic resection, read the radiology report and how they described the tumor, what their differential diagnosis is, what symptom lead to them doing radiology etc. Then read the pathology report, what type of tumor it is, what is the TNM stage, how does staging affect their treatment choice etc. Then you can read the progress report, what complication they had post op, what neoadjuvant treatment that patient will receive, what kind of of follow-up (Eg. repeat scope, yearly CT etc) they'll receive etc.

And I forgot one thing about YT videos. that's try to replicate some of the material for better memorization. For example if the video has a really good table outlining differential diagnosis for nephrotic syndrome, rather than just look at it, pause the video and copy out the table yourself using pen and paper. Then throw out the piece of paper and copy it again. After you copy the table 3 times I bet you can recall most of ddx from memory now.  Same with diagrams, buy a cheap white board from dollar store, and copy the diagrams in the video as you watch the video. I found this extremely helpful because then the image of that diagram gets ingrained in my mind very quickly. 

Lastly I know it can feel bad to not work as hard as everyone else because you feel like you let the team down, but in reality you need time for yourself to study and recover etc. If you don't wanna scrub in and want to study for bit instead I think most residents should be ok with that. If a team cannot function with 1 less medical student then there's something wrong with that team lol. So I say if you are on the brink and need to take a break or take a day off, just do it. I used to feel like I should always work harder to try help get things done, but honestly patients come and patients go, and sometimes without better infrastructure and other supports in place, working harder is just like scooping water out of a leaky ship aka the hospital system, the ship is still sinking lol, just a matter of faster or slower lol. 

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19 minutes ago, lovemedicinesomuch said:

I am so sorry. I had a similar experience in Gen Surgery, except my week was 80+ hours. Surgery is service-based rotation, and I don't think you are there to learn as much as do whatever you are told to do.. Now, to help you pass, I used the following:

- paul bolin - Gen surgery videos

- Osmosis - Gen surgery videos + all the other surgery videos

- case files

Got 85% on my shelf exam :) Not a 100% but a decent score for someone who hates surgery!

Other strategies I used to get time off during Surgery

- submitted a conference abstract --> got a free day off

- used a flex day

Now I got 2  days off during Gen Surgery to study before exam. 

The way medical education is structured is literally to exploit juniors unfortunately.. but just remember it is another hoop - it's probably the last time in your life you have to do surgery if you are not interested.  Some staff/residents really don't care about you at all - it's a very unfortunate system. Just remember when you are staff or resident to try and teach your junior something useful, instead of constantly expecting them to do all your work and not returning favour.. the worse thing in Gen Sx was that they were not even grateful that I was doing their work like in most other rotations... 

 

Good luck and reach out if you need anything :)

If I may add few more recommendations on YT:

armando hasudungan - really nice diagrams and animations

medicosis perfectionalis - guy has weird jokes and weird voice but teaching is on point

For anything radiology related:

radiopaedia website

For anything pathology related:

Libre pathology website

 

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  • 3 weeks later...

Clerkship you gotta learn on your own. A lot of mine was scut work and other BS.

On 4/12/2021 at 2:32 PM, medmedmed132 said:

I just did a rotation in a core specialty (surgical), and felt like I was just there to do the work of the team, and get the job done. I learned literally nothing, and worked easily 50-60 hours a week. To top it all off, my school has shelf exams, and I failed by one mark. I'm pretty angry - not only were we not taught the things relevant on the exam during the rotation, we grinded out 50-60 hours (some weeks were night shifts) and still learned nothing.

Is med school just unpaid labour?

That's just how most general surgery rotations are. Scut work, pimping, and stressed out & overworked residents.  You have to just study on your own when you have time. 

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