Future Attendings? Yeah Right.

By:  The Generation Y Surgeon (@GenYSurgeon)

I Hear This On A Daily Basis

 

I hear it nearly everyday now:

“They’re just not ready…”

“When I was a resident we would do ___, nowadays residents don’t even know what ___ is.”

“This patient is VIP so I will do most of the case…”

“We need the real attending before we can start the case.”

“They seem too young…”

And on and on.  As a graduating resident I find myself bombarded with demotivating, confidence destroying comments and feedback. Even as I interviewed for fellowship, I was encouraged to take the longer training option…from people who had never met me let alone see me in a clinical setting!  In almost every aspect of my training I feel the wrong kind of pressure:  it’s the kind of critical, demoralizing pressure that kills confidence and raises unproductive concerns instead of the feedback and constructive criticism that will help my colleagues and I grow into junior attendings.

Not What We Signed Up For

I signed on to surgery with an understanding that I would be trained and groomed by surgeons until I was a surgeon myself.  It was supposed to be that, during my five (or more!) years of training, the wise men and women would cultivate me into their likeness.  My naiveté would be replaced with the knowledge of the mentors who footsteps I followed, and that by the end of my residency I would be a surgeon-product that my predecessors would be proud to let fly and with which they would be proud to be associated.  Instead of graduating with cautious confidence and the immature skill set of a surgeon set to succeed on his/her own, I’m leaving my residency with a ticket to fellowship…and a head full of crippling, often useless, and often derogatory feedback.

Maybe I assumed wrong, or maybe I’ve too idealistic (unlikely), but I thought being a surgeon was about being a leader…a leader in the trauma bay, in the OR, and in the ICU.  So if I’m supposed to be  a confident, skilled leader then shouldn’t confidence and leadership be part of my training?

One Bad Idea On How To Fix A Broken System:  Make It Take Longer

General Surgery News just published an article about a surgeon’s proposal for a fellowship requirement after Surgery (read it here:  http://www.generalsurgerynews.com/ViewArticle.aspx?d=Opinions+%26+Letters&d_id=77&i=May+2014&i_id=1062&a_id=27491).

This surgeon stressed that his personal views are not those of the ABS; however, these are the personal views of a real thought leader in our field.

This article does an excellent job of outlining the barriers we face in improving resident education, including the 80-hour workweek and reduced autonomy in our current hospital systems; however, I don’t think you can blame the 5-year system for any shortcoming.  Before another year (or two) is added to the training schedule, aren’t we are obligated to fix what happens within the 5 years?

Can’t We Innovate Some Better Way Than Tacking On More Years To A Broken System?

For example improving the curriculum (SCORE has been a good first step), increasing dry-lab training and building in some meaningful training in leadership.  Furthermore, there’s much room for improvement when it comes to building confidence and loosening the “leash” as residents approach the end of their training.  Instead of being treated like a junior resident, chiefs should be treated like the attendings they are supposed to become in upcoming months.  It’s not just being able to start a case, it’s being able to run a team and assume the duties of an attending (as well as shedding some of the menial duties of being a resident).  This confidence should come not only from the attendings but from how juniors treat the chiefs as well.  Somewhere along the way, we’ve lost that hierarchy that used to exist within residency and along with it some of the inherent leadership that came with the roles.

I wonder if a mandatory fellowship would solve any of the problems identified in this article, by attendings or residents, regarding the quality of the final products of residency training (graduating chiefs).  Is adding time to our training really the answer?  I doubt it.  We need to change the content and culture of our training to find a better way to use the time we have.

Residents & Students:  Don’t Accept More Years Until We’ve Tried To Fix What We Have

I urge you to read the article, especially junior residents and medical students!  A mandatory fellowship turns 5 years into 6 or 7 years, maybe more.  That’s a long time to be a resident/fellow and that time requirement may influence your decision to pursue General Surgery.  If you’re spending that much time in training, then why not go into integrated plastics or vascular?  Or a different field altogether like cardiology or interventional radiology?  And for physicians who plan on working in rural and underserved areas as general surgeons, this is just another barrier….but that’s a whole other blog entry.

We face physician shortages in all fields these days, and especially in Surgery.  It’s important that we find a way to produce confident and effective surgeons and learn to do it in a timely fashion…or soon we will be graduating geriatric surgeons who need crutches both in and out of the operating room!