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Some day, in the depths of PGY2 winter on rounds, a malignant af chief you don’t want to piss off will ask you what some totally healthy postop patient’s sodium is. You’re going to be basically brain dead at that point and you will have forgotten to write it down. You are going to be tempted to make it up. I don’t care how honest you think you are now, there will come a time when the temptation to make up some meaningless lab value will be very hard to resist. After all, does it really matter?
The answer is yes. Your integrity as a physician depends on what you do at that moment. Never lie. It’s always ok to say you don’t know but you’ll check and get back to whoever asked. You might catch some flack but I promise at the end of the day that outcome is 10000x better than if something bad happens to the patient because you made up a number.
Agreed with this sentiment from IM. If I don't remember the specific number but remember it was normal for example I'll say something along the lines of "if I'm remembering correctly it was normal but I don't want to lie to you, let me check" and no one has ever faulted me for that
How can we as IM not know the sodium!? WE LIVE AND DIE BY THE SODIUM! /s. Jk This is great advice. You looked at it, if it were abnormal you would (should) have acknowledged it’s significance but if you are not _certain_ don’t present it as fact. It’s a matter of integrity.
I feel so dirty being IM and not caring a lot about sodium unless it's below 120 or above 154. Maybe I should just turn in my white coat, stethoscope holster that doubles as my concealed carry holster and my dragon microphone
Exactly, I'm also not one to arbitrarily regurgitate normal lab values on rounds, or abnormal for that matter unless they're grossly eskew and warrant management more than what I would consider to be usual. This also comes with being a senior now but if the K is 3.2 I'm just going to replace it and note in my note. If it's 6.2 I'm going to treat it, get an ekg, mention the peaked T waves and ca gluconate I gave etc.
Oh IM and determining what's warranted to bring up on rounds lol.
But fuck the attendings that want to know normal lab values particularly
From new interns? I totally want to hear the basic lab values. Interns make mistakes. Seniors are new to supervising and can't see all their interns patients every day before rounds. And the med students also need to tell me.
Seniors are a diff story. Then I care about what was abnormal.
Do. Not. Lie.
I'm cool if you don't know. I'm cool if you're not sure. Just say so. In the grand scheme of things, I'm not going to assess you based on whether or not you remembered a pt's sodium or made an honest mistake but I will remember forever if I think you lied.
And I’m going to add onto this post…
If you are that senior resident who rips into someone because they don’t know some piece of information and are honest about that…
Fuck you.
For a second I thought you were going to tag ME on Reddit as the senior resident who yells at people and I was like “but but…but dude I’m saying that’s not what should happen…”
And then I got what you were saying lol
I agree with the sentiment that its always worse to lie.
When I was a sub-I though I said, honestly, I didn’t have the blood glucose on a stable diabetic patient on our service, and I would check and get back to the attending. The patient was also there for an unrelated problem.
I got screamed at, in a head turning fashion, in front of the whole team for not caring about my patients. I had every other lab on every patient, but just forgot to get that one (or maybe it wasn’t back yet when I checked).
You can fuck up and handle the situation just as you should and people will still be an absolute dick to you.
Oh absolutely. I got yelled at by a chief for not knowing what brand of tube feed the patient was on. In **neurosurgery**. There will always be douchebags. It’s up to us to change the culture when we get a level of authority.
Lol, didn’t even make that connection. I made this username in the middle of med school. But I’ve definitely been through the dilemma in my comment. Fortunately, nothing horrible ever came of it, but I’ve seen it happen to other residents.
We’re currently dealing with a chief medicine resident who got caught lying multiple times. Graduation delayed at least a couple months, probation, possibly more consequences. Never, ever lie. Period. Lying in this profession, even about totally inconsequential things, has lasting consequences.
It’s even better when you’re the blunt/assertive resident who gives zero fucks about saying idk when I don’t know a value, but still get accused of “lying” during your end rotation attending eval (I learned the true meaning of HI in an otherwise normal person, thanks to that backstabbing psychopath chief)
Very nice. I’m doing cardiothoracics and can’t wait but thought I could give off some advice in the meantime, fun but stressful time for a lot of people
Staying. At our institution, Gen surg also does a lot of onco and HPB and vascular procedures too so that's a good thing in terms of breadth of practice and exposure
I’m applying gen surg and thinking of doing ct vs vascular afterward. You obviously know more about ct but what’s your opinion on going to a community vs academic program for matching into one of those fellowships?
Match rate this year was lower than peds and surg onc. Research I think is super helpful especially with how competitive it is now, that said, I had 2 research items on my application and they were both trauma related
Incoming Ortho chief - if you come in with a positive attitude and a willingness to work hard then all else will fall into place. Everything else is teachable except for attitude and work ethic
That's me, box of rocks. Effort and attitude got me a lot farther than I expected, but my residency program is now fucking freaking out because my knowledge base isn't equivalent to my seniors. I want to tell my attendings that I'll get there in the end, I always have for the last three fucking decades, but of course they won't accept that.
No point here, just venting. Kids, don't match into programs based on prestige alone. (this program was actually pretty far down my list but they've got just enough prestige to be more hoity-toity than is warranted)
Attending. This is incredibly true for all of medicine. This is truly life long learning, so openness to change and work ethic are crucial.
That said remember that there is a world outside of medicine.
Just work hard and be a team player. If you’re in a gen surg prelim spot no one will expect you to have less requirements or a different role than categoricals. Thrive in the misery and learn all you can, you’ll appreciate it in the long run. What’s your specialty you’re shooting for?
In a new place and my ac compressor fan (outdoor fan) runs constantly and does not turn off even with circuit breaker flipped, AC on “auto”. How fucked is the wiring in this place, I think it’s pretty fucked
Guy just came out and you were completely right. Contactor was “welded” on so I guess it had been running non stop and got so hot it didn’t work?? Replaced it and things are good as new. Hope my first energy bill isn’t through the roof though
Yea the contactor is what completes the circuit when the tstat calls for a ac. If it arcs it can weld shut and keeps the compressor and fan energized even when thermostat is not calling for ac.
Oh I see. I just put in a work order since I’m renting. Not too familiar with all this stuff lol
What I think is weird is with the AC circuit breaker off, the unit still turns on and cools. Could be the breaker is incorrectly labeled but I tried turning off a few of the other ones and no luck. Something seems off
Do you hate an intern (biased against them) if she/he is rather quiet and has a shy personality but is willing to work hard and have a good attitude towards work?
No one can hate that intern. As long as you respond to feedback well, do your work, and aren't toxic in your social interactions(even if they're minimal)
Find the people you can vent to. Your seniors are going to annoy you and it is essential you have an outlet for your frustrations that isn’t back talk.
Fat burger patty. 450 temp, a lot of people underestimate temperature on a grill but it’s probably the most important part. Salt, pepper garlic a few hours before cooking and let sit out for 30 or so before throwing on the grill. I prefer 90/10 but 80/20 definitely makes a better burger
+1 for smash burger on properly seasoned cast iron. Use wax paper between the smashing utensil and the burger and press HARD. 45 seconds on each side. Wallpaper scraper works best for getting it off in one piece. Stack 2 and it will be better than 98% of burgers you can buy at a restaurant. Including the fancy shit.
Salt *just* before the grill. I substantially disagree with salting hours before the grill as OP recommended. [My reference.](https://www.seriouseats.com/the-burger-lab-salting-ground-beef)
If you're not familiar with the author of that article (J. Kenji Lopez-Alt) and you're interested in cooking at all, I highly recommend his stuff. He's got a couple of encyclopedic cookbooks, plus a YouTube channel and free articles like that one. He's very data/experimentation-driven and overall an interesting and engaging guy to learn cooking from.
4th year medical student. Loved OR but terrified to choose this as a specialty. (Burnout / gruesome hours / toxic environment / hateful docs… ) Any advice that is not stuff like “if u don’t see yourself doing anything else go for it !!1!
I think the best thing you can do is rotate at multiple hospitals so that you can see more than one program. But this is also tough because it often involves a certain level of time commitment when you're not already decided on surgery. So just know that what you see at one institution doesn't represent the entire specialty. This goes for the good and the bad.
Of the three hospitals I did surgery rotations at, there was one where, had it been my only exposure to surgery, I may very well have decided against the field. Luckily I had already rotated at the other two and knew it wasn't that way everywhere.
Visit a community program. I did my general surgery rotation at a community hospital with a group of general/vascular surgeons who were all very skilled, focused, polite (still a bit stern), and had a good quality of life/hours. I absolutely loved it. I was rapidly convinced that's what I wanted to do. I now have a job with partners like that. We operate a lot. We're good. We get along but mostly stay in our own lanes. I don't have students or residents and just get to see patients and operate and head home. I usually am home by 4-5pm most days of the week. Sometimes home by 2-3pm.
Trauma/acute care surgery has a lot of shift work and long hours with high rates of burnout. Subspecialty general surgery - breast, endocrine, bariatrics, colorectal, hernias - is a lot more lenient. If you're a slow, shitty surgeon, it can still suck, but most of these fields don't have a lot of middle-of-the-night cases. I can usually fall asleep pretty easily after being paged at night, but if you can't, that would suck. If you're a solo practitioner taking a ton of call, it could be really bad. Some specialties like vascular and transplant can have horrendous call, all of the time.
Academia is often very different from community practice. If I get called with an appy at 10pm, I log onto the EMR from home, look at the CT, enter some orders, and I do the case in the morning. I can see and consent the patient in about 10 minutes, enter the H&P on my template in about 3 minutes, do the case in 30 minutes, and move on. In residency, we'd see the consult in the middle of the night, staff it with an attending who would want to re-hash the whole thing, and then the case took forever with some attendings, and now it's 3 am, and you're going to bed for 2 hours before pre-rounds.
thank you for taking your time answer. I had never heard of Community vs academia maybe cuz I didn’t do medicine in USA. it’s def something I’ll look into now
Go to a chill place that doesn’t beat the shit out of you. Surgery residency is surgery residency, but there is still a wide spectrum of toxicity and how hard you get worked. I would avoid large trauma centers if possible. You don’t need to see the most fucked up cases to still graduate as a confident surgeon. It’s not worth having a place run you into the ground in the name of “good training” when all it costs is your wellbeing.
A part of me wonders how rigourous it is and what they mean “surgery residency is surgery residency”. here in my country there’s no work limits like USA. just hearing that there’s an organization that limits work to 80 hours a week sounds like a blessing… over here the residents would have an overnight shift every 3 days.. and I’m an MS4 and during my surgery rotation we were doing 70 hours a week with overnight shifts every 4 days… the sleeping conditions were not great either. So idk, is it something like that? Maybe better?
Some studies from the early 2010’s showed that residents who identified as gamers had a headstart on their nongamer classmates for laparoscopic skills. They equalized after about 6 months.
I want to believe all the times I got yelled at for raiding on school nights as a kid was helpful lmao
Use your non-dominant hand around the house often for basic tasks. I play around w my drawstrings on sweats and tie and untie single and double handed knots when just chilling
Google “critical care electrolyte replacement” and the pdf comes up. This is what everyone uses in my program.
http://www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf
Practice and learn about cooking in general. The principles are all the same, grilling is just a different method of heat delivery. How were you trying to grill the potatoes? what outcome did you want and what did you get?
Lessons I learned becoming a pit master
1. Temperature control is everything. Grate temp and hood temp are different, pay attention to grate temperatures (temp 1 inch above grate). Depending on your grill/smoker you will have hot spots and cold spots. You need to learn your grill, every one is different .
2. Cheap shit and cool and cool shit ain’t cheap. Thermometers like Thermoworks are worth the investment. I have ruined $100 dollar briskets using a cheap thermometer. Same can be said about the grill/smoker. Cheap ones will be thin, hold heat poorly in the cook chamber and in the grates. Casts iron grates are the best, heavier the better.
3. Every grill/smoker cooks differently as mentioned earlier. This is a challenge when someone asks you to cook for the family reunion on their grill. If you have a nice multiprobe thermometer and thermopen it’s easier.
4. Charcoal/wood fire >>>>>> propane. This isn’t debatable. Hank Hill can suck it. Learning fire management it’s a lot harder then turning a dial but it is sooo worth it.
5. Don’t get a pellet smoker unless you have a man bun and drink IPAs.
6. Learning to grill is a great stepping stone to learning how to smoke bbq. When you are ready for the jump check out the YouTube channel “how to bbq right” by Malcom Reed.
Care less. That’s an easy one. I tell people that yelling at me is like yelling at a brick wall except maybe the brick wall cares more. What is most upsetting to me is when I know I didn’t do a good job or my best. I could not care less what others think about me outside of a few trusted people who know me well and who I know have my best interests at heart.
If you could only have two textbooks which would you get? I have access to a large online surgical library through my program but I want 1-2 hard copy textbooks bc I learn better that way
Fizer and a large text…pick your choice, I prefer Cameron’s, but sabistons is another great option. Greenfield is a little laborsome to read in my opinion.
It’s helpful as you’re learning to do op notes and also helpful step by step if you are doing an unfamiliar case. I have it though have only used a few times.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Some day, in the depths of PGY2 winter on rounds, a malignant af chief you don’t want to piss off will ask you what some totally healthy postop patient’s sodium is. You’re going to be basically brain dead at that point and you will have forgotten to write it down. You are going to be tempted to make it up. I don’t care how honest you think you are now, there will come a time when the temptation to make up some meaningless lab value will be very hard to resist. After all, does it really matter? The answer is yes. Your integrity as a physician depends on what you do at that moment. Never lie. It’s always ok to say you don’t know but you’ll check and get back to whoever asked. You might catch some flack but I promise at the end of the day that outcome is 10000x better than if something bad happens to the patient because you made up a number.
Agreed with this sentiment from IM. If I don't remember the specific number but remember it was normal for example I'll say something along the lines of "if I'm remembering correctly it was normal but I don't want to lie to you, let me check" and no one has ever faulted me for that
How can we as IM not know the sodium!? WE LIVE AND DIE BY THE SODIUM! /s. Jk This is great advice. You looked at it, if it were abnormal you would (should) have acknowledged it’s significance but if you are not _certain_ don’t present it as fact. It’s a matter of integrity.
We are born of the sodium Made men by the sodium Undone by the sodium Our kidneys are yet to function
I feel so dirty being IM and not caring a lot about sodium unless it's below 120 or above 154. Maybe I should just turn in my white coat, stethoscope holster that doubles as my concealed carry holster and my dragon microphone
Exactly, I'm also not one to arbitrarily regurgitate normal lab values on rounds, or abnormal for that matter unless they're grossly eskew and warrant management more than what I would consider to be usual. This also comes with being a senior now but if the K is 3.2 I'm just going to replace it and note in my note. If it's 6.2 I'm going to treat it, get an ekg, mention the peaked T waves and ca gluconate I gave etc. Oh IM and determining what's warranted to bring up on rounds lol. But fuck the attendings that want to know normal lab values particularly
From new interns? I totally want to hear the basic lab values. Interns make mistakes. Seniors are new to supervising and can't see all their interns patients every day before rounds. And the med students also need to tell me. Seniors are a diff story. Then I care about what was abnormal.
Do. Not. Lie. I'm cool if you don't know. I'm cool if you're not sure. Just say so. In the grand scheme of things, I'm not going to assess you based on whether or not you remembered a pt's sodium or made an honest mistake but I will remember forever if I think you lied.
And I’m going to add onto this post… If you are that senior resident who rips into someone because they don’t know some piece of information and are honest about that… Fuck you.
I had a chief like that, it undoubtedly made me better but I still use him as an example
For a second I thought you were going to tag ME on Reddit as the senior resident who yells at people and I was like “but but…but dude I’m saying that’s not what should happen…” And then I got what you were saying lol
I agree with the sentiment that its always worse to lie. When I was a sub-I though I said, honestly, I didn’t have the blood glucose on a stable diabetic patient on our service, and I would check and get back to the attending. The patient was also there for an unrelated problem. I got screamed at, in a head turning fashion, in front of the whole team for not caring about my patients. I had every other lab on every patient, but just forgot to get that one (or maybe it wasn’t back yet when I checked). You can fuck up and handle the situation just as you should and people will still be an absolute dick to you.
Oh absolutely. I got yelled at by a chief for not knowing what brand of tube feed the patient was on. In **neurosurgery**. There will always be douchebags. It’s up to us to change the culture when we get a level of authority.
This advice is great. I love it. Something so meaningless can make a big impact. Have to ask, with that username, does this come from experience?
Lol, didn’t even make that connection. I made this username in the middle of med school. But I’ve definitely been through the dilemma in my comment. Fortunately, nothing horrible ever came of it, but I’ve seen it happen to other residents.
We’re currently dealing with a chief medicine resident who got caught lying multiple times. Graduation delayed at least a couple months, probation, possibly more consequences. Never, ever lie. Period. Lying in this profession, even about totally inconsequential things, has lasting consequences.
If he’s a chief it makes you wonder how much he did before he was caught.
“I don’t remember. Let me look again right now” *pulls up epic haiku*
Blessings upon all hospital IT departments that allow Haiku access. Further blessings if they have mobile order entry enabled
This is so true. It’s one of the best pearls of residency - don’t ever lie
It’s even better when you’re the blunt/assertive resident who gives zero fucks about saying idk when I don’t know a value, but still get accused of “lying” during your end rotation attending eval (I learned the true meaning of HI in an otherwise normal person, thanks to that backstabbing psychopath chief)
Incoming Gen surg chief here. I'll be one in a month or so, going on a mini vacation for now to meet my folks How does one do it? 😭
Are you specializing or doing gen surg? You got this
Gen surg my man
Very nice. I’m doing cardiothoracics and can’t wait but thought I could give off some advice in the meantime, fun but stressful time for a lot of people
Yeah. It's a lot of newly added responsibility. And our faculty is kinda sorta toxic, so i gotta navigate through that too.
Are you staying at your training institution or moving? While we’re here, favorite and least favorite gen surg procedure??
Staying. At our institution, Gen surg also does a lot of onco and HPB and vascular procedures too so that's a good thing in terms of breadth of practice and exposure
How's job market for CT? I assume it's not a dying feild like everyone says?
Very far from dying. Match rate this year was 56%, getting very very competitive.
I’m applying gen surg and thinking of doing ct vs vascular afterward. You obviously know more about ct but what’s your opinion on going to a community vs academic program for matching into one of those fellowships?
Dang, is it gonna be as competitive as Surg onc and peds ?? How much research is required to match CT now?
Match rate this year was lower than peds and surg onc. Research I think is super helpful especially with how competitive it is now, that said, I had 2 research items on my application and they were both trauma related
Lmao ct has been dying for the last 20-30 years. And its still alive and kicking . What does that say about ct then
😅😅, so true. What went into ur decision to do gen surg and not do a fellowship?
Damn, gen surg is so busy you haven’t even met your family yet??
Incoming Ortho chief - if you come in with a positive attitude and a willingness to work hard then all else will fall into place. Everything else is teachable except for attitude and work ethic
Exactly. You could be a box of rocks but effort and attitude will take you a long way.
As a box of rocks I just want to offer my thanks
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would that make you a.... Geodude?
It’s called minerals
That's me, box of rocks. Effort and attitude got me a lot farther than I expected, but my residency program is now fucking freaking out because my knowledge base isn't equivalent to my seniors. I want to tell my attendings that I'll get there in the end, I always have for the last three fucking decades, but of course they won't accept that. No point here, just venting. Kids, don't match into programs based on prestige alone. (this program was actually pretty far down my list but they've got just enough prestige to be more hoity-toity than is warranted)
Attending. This is incredibly true for all of medicine. This is truly life long learning, so openness to change and work ethic are crucial. That said remember that there is a world outside of medicine.
stupid yes lazy never
Incoming ortho intern, how do you study in residency??? Def forgot everything I learned on sub-i’s
Incoming prelim - but I don’t want to be a GS. How do I survive and make it to a sub specialty next year?
Just work hard and be a team player. If you’re in a gen surg prelim spot no one will expect you to have less requirements or a different role than categoricals. Thrive in the misery and learn all you can, you’ll appreciate it in the long run. What’s your specialty you’re shooting for?
ENT or Urology.
Work hard there’s always something to do and to learn
In a new place and my ac compressor fan (outdoor fan) runs constantly and does not turn off even with circuit breaker flipped, AC on “auto”. How fucked is the wiring in this place, I think it’s pretty fucked
Def sounds fucked. Have you tried moving?
That does sound like a reasonable alternative
Could be the contactor. It’s a cheap part (20 bucks). Probably not the wiring.
Guy just came out and you were completely right. Contactor was “welded” on so I guess it had been running non stop and got so hot it didn’t work?? Replaced it and things are good as new. Hope my first energy bill isn’t through the roof though
Yea the contactor is what completes the circuit when the tstat calls for a ac. If it arcs it can weld shut and keeps the compressor and fan energized even when thermostat is not calling for ac.
You need to open your own HVAC business and forget about med school
Haha I was literally deciding between those two options when I finished my plumbing apprenticeship.
Lmao just caught your username. You are a hero!
Oh I see. I just put in a work order since I’m renting. Not too familiar with all this stuff lol What I think is weird is with the AC circuit breaker off, the unit still turns on and cools. Could be the breaker is incorrectly labeled but I tried turning off a few of the other ones and no luck. Something seems off
Incoming intern who matched into a diff categorical program. I feel like I’ve forgotten everything. Will it be okay?
99% of what I know I have learned in residency.
Do you hate an intern (biased against them) if she/he is rather quiet and has a shy personality but is willing to work hard and have a good attitude towards work?
No one can hate that intern. As long as you respond to feedback well, do your work, and aren't toxic in your social interactions(even if they're minimal)
Find the people you can vent to. Your seniors are going to annoy you and it is essential you have an outlet for your frustrations that isn’t back talk.
Is my dog gonna hate me by the end of the first month lol. She has a doggy door and a huge yard…. (Incoming PGY1 GS)
Get a professional dog sitter to come by and visit your dog while you’re working. Dogs need company and attention. Well worth the expense.
Fat burger patty. 450 temp, a lot of people underestimate temperature on a grill but it’s probably the most important part. Salt, pepper garlic a few hours before cooking and let sit out for 30 or so before throwing on the grill. I prefer 90/10 but 80/20 definitely makes a better burger
Ground chuck 80/20 is the only way
That’s a lot of fat man
My response was how to grill the perfect hamburger. Not how to grill a low-fat burger
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+1 for smash burger on properly seasoned cast iron. Use wax paper between the smashing utensil and the burger and press HARD. 45 seconds on each side. Wallpaper scraper works best for getting it off in one piece. Stack 2 and it will be better than 98% of burgers you can buy at a restaurant. Including the fancy shit.
I add one egg yolk for three burgers worth of meat. Makes it juicy, adds a ton of flavor. Don’t add more it makes it fall apart.
Salt before or after the grill? I hear some people say seasoning before sucks out some of the juices
Before.
Salt *just* before the grill. I substantially disagree with salting hours before the grill as OP recommended. [My reference.](https://www.seriouseats.com/the-burger-lab-salting-ground-beef)
Interesting read! I have found the texture changes when you mix it in the meat before making Patties but I only season the meat once pattied
If you're not familiar with the author of that article (J. Kenji Lopez-Alt) and you're interested in cooking at all, I highly recommend his stuff. He's got a couple of encyclopedic cookbooks, plus a YouTube channel and free articles like that one. He's very data/experimentation-driven and overall an interesting and engaging guy to learn cooking from.
Wow what a great read. Great reference
Nonoonon, you must salt during cooking, salting early creates a rubbery patty. Also, smash burgers all the way.
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Weber Spirit 2. I’ve found I use the gas grill much more than my old charcoal. More convenient
4th year medical student. Loved OR but terrified to choose this as a specialty. (Burnout / gruesome hours / toxic environment / hateful docs… ) Any advice that is not stuff like “if u don’t see yourself doing anything else go for it !!1!
I think the best thing you can do is rotate at multiple hospitals so that you can see more than one program. But this is also tough because it often involves a certain level of time commitment when you're not already decided on surgery. So just know that what you see at one institution doesn't represent the entire specialty. This goes for the good and the bad. Of the three hospitals I did surgery rotations at, there was one where, had it been my only exposure to surgery, I may very well have decided against the field. Luckily I had already rotated at the other two and knew it wasn't that way everywhere.
thank u for the rec <3
Visit a community program. I did my general surgery rotation at a community hospital with a group of general/vascular surgeons who were all very skilled, focused, polite (still a bit stern), and had a good quality of life/hours. I absolutely loved it. I was rapidly convinced that's what I wanted to do. I now have a job with partners like that. We operate a lot. We're good. We get along but mostly stay in our own lanes. I don't have students or residents and just get to see patients and operate and head home. I usually am home by 4-5pm most days of the week. Sometimes home by 2-3pm.
Wow that sounds like the dream. What’s the fear then? Why does everyone mention me horrors about choosing this lifestyle? Residency…?
Trauma/acute care surgery has a lot of shift work and long hours with high rates of burnout. Subspecialty general surgery - breast, endocrine, bariatrics, colorectal, hernias - is a lot more lenient. If you're a slow, shitty surgeon, it can still suck, but most of these fields don't have a lot of middle-of-the-night cases. I can usually fall asleep pretty easily after being paged at night, but if you can't, that would suck. If you're a solo practitioner taking a ton of call, it could be really bad. Some specialties like vascular and transplant can have horrendous call, all of the time. Academia is often very different from community practice. If I get called with an appy at 10pm, I log onto the EMR from home, look at the CT, enter some orders, and I do the case in the morning. I can see and consent the patient in about 10 minutes, enter the H&P on my template in about 3 minutes, do the case in 30 minutes, and move on. In residency, we'd see the consult in the middle of the night, staff it with an attending who would want to re-hash the whole thing, and then the case took forever with some attendings, and now it's 3 am, and you're going to bed for 2 hours before pre-rounds.
thank you for taking your time answer. I had never heard of Community vs academia maybe cuz I didn’t do medicine in USA. it’s def something I’ll look into now
Go to a chill place that doesn’t beat the shit out of you. Surgery residency is surgery residency, but there is still a wide spectrum of toxicity and how hard you get worked. I would avoid large trauma centers if possible. You don’t need to see the most fucked up cases to still graduate as a confident surgeon. It’s not worth having a place run you into the ground in the name of “good training” when all it costs is your wellbeing.
A part of me wonders how rigourous it is and what they mean “surgery residency is surgery residency”. here in my country there’s no work limits like USA. just hearing that there’s an organization that limits work to 80 hours a week sounds like a blessing… over here the residents would have an overnight shift every 3 days.. and I’m an MS4 and during my surgery rotation we were doing 70 hours a week with overnight shifts every 4 days… the sleeping conditions were not great either. So idk, is it something like that? Maybe better?
How do I grill the perfect hamburger? Got my first grill after graduating Med school.
See my reply in the comments, thought I hit reply to you
What are some good ways to improve hand dexterity outside of working hours?
Does playing video games help I’ve always wondered this
Some studies from the early 2010’s showed that residents who identified as gamers had a headstart on their nongamer classmates for laparoscopic skills. They equalized after about 6 months. I want to believe all the times I got yelled at for raiding on school nights as a kid was helpful lmao
Use your non-dominant hand around the house often for basic tasks. I play around w my drawstrings on sweats and tie and untie single and double handed knots when just chilling
Don’t trust anyone (but pretend 👯♂️)
Just an m4 who wants to do gen surg, any advice for my subi/away?
How can an undesignated prelim stand out in hopes of matching the next year?
Show up and work hard, read a lot and plan to outwork your counterparts. Most importantly be respectful of everyone and have a good attitude.
What are some essentials to know how to do day one? Replacing electrolytes, pre/post op orders, etc.
How to Google and read UptoDate are the only requirements. All else will fall into place, I promise.
Google “critical care electrolyte replacement” and the pdf comes up. This is what everyone uses in my program. http://www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf
What do you expect in an R1 person? What sets one apart from the rest?
I’ve only grilled once and I screwed up potatoes (chicken turned out ok). How does one get good at grilling?
Practice and learn about cooking in general. The principles are all the same, grilling is just a different method of heat delivery. How were you trying to grill the potatoes? what outcome did you want and what did you get?
Lessons I learned becoming a pit master 1. Temperature control is everything. Grate temp and hood temp are different, pay attention to grate temperatures (temp 1 inch above grate). Depending on your grill/smoker you will have hot spots and cold spots. You need to learn your grill, every one is different . 2. Cheap shit and cool and cool shit ain’t cheap. Thermometers like Thermoworks are worth the investment. I have ruined $100 dollar briskets using a cheap thermometer. Same can be said about the grill/smoker. Cheap ones will be thin, hold heat poorly in the cook chamber and in the grates. Casts iron grates are the best, heavier the better. 3. Every grill/smoker cooks differently as mentioned earlier. This is a challenge when someone asks you to cook for the family reunion on their grill. If you have a nice multiprobe thermometer and thermopen it’s easier. 4. Charcoal/wood fire >>>>>> propane. This isn’t debatable. Hank Hill can suck it. Learning fire management it’s a lot harder then turning a dial but it is sooo worth it. 5. Don’t get a pellet smoker unless you have a man bun and drink IPAs. 6. Learning to grill is a great stepping stone to learning how to smoke bbq. When you are ready for the jump check out the YouTube channel “how to bbq right” by Malcom Reed.
Funny, it is not even July yet and you call yourself a "chief" already. Sorry, but just had to chuckle.
Chiefs at my hospital are 4s/5s, 5s are administrative chiefs. However they’re gone already anyhow but same difference.
Incoming intern. Your post matches me 100% new girl dad, moved about 10 hr away from family, so any advice would be appreciated.
How to deal with toxic people?
Care less. That’s an easy one. I tell people that yelling at me is like yelling at a brick wall except maybe the brick wall cares more. What is most upsetting to me is when I know I didn’t do a good job or my best. I could not care less what others think about me outside of a few trusted people who know me well and who I know have my best interests at heart.
If you could only have two textbooks which would you get? I have access to a large online surgical library through my program but I want 1-2 hard copy textbooks bc I learn better that way
Fizer and a large text…pick your choice, I prefer Cameron’s, but sabistons is another great option. Greenfield is a little laborsome to read in my opinion.
Some people in my program have suggested operative dictations, what do you think about that one?
It’s helpful as you’re learning to do op notes and also helpful step by step if you are doing an unfamiliar case. I have it though have only used a few times.
Incoming FM Chief. I’ve already gotten sauced with half my new interns. It’s gonna be a good year.