| Rules and regulations |
Rules and regulations have altered the medical student experience, making it more difficult to have adequate exposure to the rigors of residency. |
“We’re very busy and the pressure is to do more in less time and, quite frankly, medical students slow things down and so just to get patients through the system there’s probably less that they have to do or an opportunity for them to do it.” – Male program director, flexible hours “I don’t know that there’s anything that can prepare them besides just doing it. In the past medical students would be subinternships and take call with resident teams and be able to write notes and the culture is such they’re just not able to participate to that degree. Be it their own restrictions from the medical school or their time-off requirements or their vacations or lack of interest per se.” – Female faculty, flexible hours “As the…quality movement has grown, I think students have totally gotten caught in the quality/patient safety machine. If I look back on my own education and the things I was permitted to do as a medical student, there’s no way on this earth we’d permit students to do that today, in today’s environment. It just wouldn’t be deemed appropriate or acceptable.” – Male faculty, standard hours
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| Overnight call |
Exposure to overnight call is an important aspect of preparation for surgical residency. However, the experience on call is more important than the mere presence of call. |
“Part of it is because they come so unprepared. To give you an example at our institution, our medical students don’t take any call. They do some overnight shifts, but those overnight shifts they tend to hide in the library and don’t come out.” – Male program director, standard hours “I think a lot of the changes that we’re seeing happening in the residency nationally have been mirrored in medical school…[W]hen I trained…my medical students were amazing…[M]edical students were allowed to take call with the residents at night. They…would help us put Foleys in, they would take urine specimens, and they would help write the [notes] in the trauma bay. They would help…our consults and present them back to me. I think that whole process made it more rigorous and to treat them in the trenches they were seen a little bit as junior allies to us. That was the experience I had in medical school too when I was on my surgery rotations; my residents generally allowed me to go and see consults and would have me do some of the stuff that an intern might do, which really prepared me for my intern year.” – Female program director, flexible hours “As a medical student we were allowed to do the same hours as a PGY2 so we were allowed to take 24-hour call and my medical school did acting internships, so we actually held the intern pager and returned the phone calls and were…expected to go see consults. I feel like that’s more than a lot of fourth year medical students get to do. And so I felt like that really helped…get you prepared a little bit.” – Female PGY1, flexible hours “Yes, there were times when I was on-call overnight. It was kind of worthless and pointless because we couldn’t do anything… My resident will be like, “Alright, men, go sleep or do whatever you want,” because you’re not actually able to participate…The biggest learning curve is…what things to worry about with patients. You don’t see that actually…because nurses aren’t calling students. You’re not aware of what is really going on unless your residents tell you.” – Female PGY5, standard hours
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| Perceptions of residency |
Medical students who arbitrate the decision to enter surgery based on an adequate perception of residency may have improved expectations. |
“For whatever reason our medical school was very, very strict about our hours as students. We would come in sometimes an hour or 2 hours after the residents and we were always made to leave by 5:00 or 6:00 PM, so the long work hours that the surgery residents are doing you know they’re tired and you know they are working hard, but you yourself don’t really fully understand that and you have none of the pressure of actually taking care of patients, so I don’t think you are like fully prepared for what you’re getting into unless you make an effort to really sit down and talk with as many surgery residents as you can to get an inside scoop.” – Female PGY3, flexible hours “I think that’s one of the biggest issues facing burnout right now actually. I think that we’ve done a real disservice to the medical students at this point giving them an improper perception of what residency means and what going to surgery means in general.” – Female program director, standard hours “…They come in with false expectations…they don’t really understand…so, yes, it’s going to be a huge shock…and I’m sure at some point in that first year they’re wondering, ‘Did I make the right decision’?” – Male program director, flexible hours “Let’s say if I had known that I would be expected to work this much I probably would not have chosen medicine to be my field but at this point I think it’s the only option for me to continue and I still enjoy it, I still like it but some days I feel that it’s just too overwhelming.” – Male PGY1, standard hours “We have a lot more medical students coming into surgery thinking this is going to be wonderful and when they have to actually figure out how the sausage is made I found they are demoralized.” – Female program director, flexible hours “We have 2 categoricals who are thinking of leaving…[T]hey didn’t feel they got an accurate picture of what being a surgeon was like as a medical student because essentially during their surgery rotations they showed up at 7, they hung out in the OR all day, which is really cool, and they went home at 4 or 5 but because of all the restrictions now… they felt that they just were very much observational… they thought they really liked surgery but when they look back at their rotations they got to just hang out in the OR all day and see cool stuff and they thought that’s what being a surgeon was about. So when they come in as interns I think there’s a big difference in some of their experience.” – Female program director, flexible hours
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