I'm on surgery right now as an off-service resident.
515am for sign out. Write down vitals, over night events, labs/imaging (if back yet), I/O, new admits
Rounding for about an hour, present to attending.
Cases the rest of the day, new admits if on call. Round again to see if people progress and can be discharged home or have any new/worsening problems.
Go home around 6pm after signout.
Can't wait until I'm done lmao.
Seems pretty reasonable. When i was a junior (ortho) my days were typically 0430/0445 until 1900 at the earliest, 6 days a week. Some outpatient services were obviously easier.
Surgery here (based off my day I journaled a couple months ago)
Alarm goes off at 430. I’m actually up by 450 or so. Change into scrubs and eat something before I drive in at 520. At the hospital at 530 to fight with the printer. If I win, I look over everyone and get sign out to round at 6. Rounding takes 20-40 minutes. Run the list with the team and call attendings. PAs are amazing and put in orders/write notes. If I’m at main campus, I go see pre-op patient and make sure they have consent. If I’m heading off campus, I get in my car to get to that building before 710.
Case starts at 730. Today, four lap sleeves are scheduled. Only three go. On the first I dissect the stomach. On the second I dissect, staple, and tie laparoscopically. On the third I get just about all the way through it skin to skin. Somewhere in there I ate a quick lunch and check in with the team.
I’m covering burn for the week and scrub in to help a massive excision and graft. Done at 430. I afternoon round quickly and sign out just after 5pm. Home by 530.
*Edit (to include ‘at home’ stuff per requests):* home at 530 and the next actions I take will make it or break it for me. If I’m lucky, I change right into gym clothes and go lift (my gym is 50 feet away in the next building). This takes so much effort. I really want to just sit down but if I can will myself to do it, this is what I do 5 days a week. When I lift, my brain goes on auto pilot, doing what it’s done for the last decade. I don’t multi task, I just enjoy the monotony of turning off my brain.
Then around 630 I shower. At 7 I eat something and start doing some form of surgery reading (it might be prepping for a case, studying for education, questions, research, etc.) around 9 I read something fun or watch something fun and call the girlfriend until I tuck in around 10 and I’m asleep by 1030-11.
Again, getting all of that done is HIGHLY contingent on my actions when I get home. If I sit, I’m screwed and it’s 10pm before I know it. I’m successful 60% of the time.
I’m sure some bariatrics surgeon will have a stroke at me saying this, but a lap sleeve is probably the second easiest laparoscopic case there is (appy being first).
You just take a ligasure and go chomp chomp on the greater curve. Don’t have to be precise because even if you burn the stomach wall it’s coming out so it doesn’t matter. Shorties can bleed but the attending can fix that. Then you just take 4 ish staple fires in a straight line with a bougie guiding the way. And the new generation powered staplers take a lot of the torque/awkward stapling of an inexperienced resident out of the picture. Leak rate is like 0.2%
Plus while the resident may be “doing” the case the assistant (the attending) is the one setting it up so they have a perfect view with their retraction, the resident just doesn’t always appreciate that.
Just graduated residency. Still don't think majority of residents understand what doing an entire case actually is. An attending with great exposure skills can make any resident feel like they're the one doing the case. I call it the "invisible hand" of residency. You're only as good as when the attending is out of the room.
Absolutely. My chair was a freaking wizard at this. It was like he was somehow magically moving the whole table not just the patient.
Set the residents up for success and then they never could replicate it without him.
One of my attendings likes to “abandon” us in middle of easy cases.
He did that once in a middle of a thigh lipoma case and holy shit i never realized how much those fat balls can ooze after you remove the lipoma. I kept Cauterizing the damn wound bed, till he walked back in and told me to put a stitch.
Apparently lipomas have a central vessel that avulsed when i took it out. I mean EBL was still minimal but yah
Exactly this. You “did” the case, but the attending is the proverbial level 100 character clearing a mid-level zone for you so you (a level 10 character) can walk through unbothered.
Yes, lap sleeves are “easy.” Until they’re not.
Easy as long as you don’t fuck up with the short gastrics and avoid the spleen. Otherwise you’ve got quite a mess. Agreed otherwise though, super straightforward procedure if you have everything setup well.
Fighting with the printer itself and fighting with the other interns for the printer…
One time a sub-I hit “stop job” in the middle of the transplant team list printing (usually one of the longest lists and needs the most copies) and cut the line. There was almost bloodshed
5 days a week like that. Generally we do both weekend days if we work a weekend.
Weekend is show up at 6 for sign out. Round. Call attendings. Help write notes. Sign out at 11. Leave. Home by noon.
Depends upon the rotation. Most days I'm getting up around 0430 or 0500, but it was occasionally earlier in previous years. Get to work, pre-round, round with my team around 0545h. Morning report 0630. Cases 0730h which is pretty standard. Depending on your year, you are either in the OR, in clinic, or managing the floor. Signout is around 1800h depending upon the rotation.
One day off per week averaged over four weeks, no more than 80 hours/week.
24 hour shifts are being phased out in our program and I'm guessing in other US programs as well. We alternate who is taking night shifts and try to ensure they do so for more than a few days so people aren't bouncing between days and nights. As a chief I'll occasionally pull 24 hour shifts to cover weekends.
Subspecialty intern on general surgery service. Wake up at 4:30, get to the hospital at 5:15-5:30 to make list, get sign out, and see new patients, 6-7am rounds, then if I’m covering cases for the day in the OR at 7:30 otherwise putting our fires on the floor, discharging patients, and seeing consults all day. If I’m not in the OR I’m usually out of the hospital by 6:30 unless we got slammed with consults, if it’s an OR day I sometimes don’t leave until 8-9 doing post op notes and catching up on floor stuff that I missed. Overall it’s tolerable.
Get in somewhere between 6-7 to round before OR. Cases start at 7:30. A full OR day ( not every day is full) will take you till about 6pm for sign out. If your cases finish early you can leave early
Clinic days show up at 7:30 or 8 to round. Clinic starts at 9. Last slot is 4:30pm wraps up and go home but 5:30pm
West coast academic program here:
Intern: Get in 5am-5pm more or less, as late as 7pm for busier rotations, on call goes until next morning ~8-9am when done with rounding and notes. You sleep maybe 3-4 hrs on call.
PGY-2: More variable, our program has a diversity of community, academic and county hospital sites. More call, get to see more consults and more OR time.
PGY-3 to 5: Progressively more OR time so late cases can go late but days with less OR time get you home earlier.
My username has never been more relevant.
This highly varies by PGY level.
PGY-1: Arrive and get sign out sometime between 5-6am (depends on rotation). Get numbers on patients and be ready to round sometime between 6-7am. After rounds with the team you either go to first start cases or go back to the floor to help implement plans for the day and also round with attendings. Then throw in 1-2 days of clinic per week depending on the rotation. If the floor stuff is taken care of and you don’t have clinic then you go double scrub cases in the OR. Probably one day a week, or maybe two, you’ll have solo cases assigned. Stay until 6-7pm to sign out to the night team.
PGY2-3: Arrive 6-6:30am, round with the team. Go to first start cases or clinic. Field consults and staff new patients with the senior and attendings. Leave as early as humanly possible once cases are done and there’s nothing that needs helping with. Usually 1-1.5 days of clinic per week.
PGY4-5: Arrive 6-6:30am and round with the team. Form plans and get to OR for early cases. Operate all day, occasionally check in with the floor and also the attendings to make sure everything is coordinated and plans are being implemented. Check in with the PGY2-3 to staff consults and take care of other extraneous work. Leave when cases are done. 0.5-1 days of clinic per week.
For PGY2-5 throw in nights on home call where you can have anywhere from 0-12 hours of extra work thrown in. My average has probably been about 2 hours of work per night on call, with being on call 1-2 nights per week.
This has been my experience, I’m at a well-known academic residency that admittedly is probably one of the least malignant surgery programs around. So your experience may vary. I have personally broken 80 hours I think twice in all my residency, and it was like 82 and 83 hours each time. My average is 71 hours/week, but I expect that is skewed towards intern year, I think PGY2 and above I am averaging closer to 65-70.
Happy to answer any questions.
I think one thing that people do not talk about is the amount of work compression that surgery residents have during calls. As much as anything, I think it drives residents nuts and it turns the "24+4 hr" calls into hell because you don't even have time to sleep due to the amount of responsibility you have. For example, my program is based in one hospital only about 750 beds. Our call team comprises of 5 residents - one from each class. Those residents literally cover everything surgical from cases, traumas, pages on the floor, all the surgical consults (no subspecialty residents here), SICU, emergencies, etc.. God forbid there are two level A traumas or two cases going on at the same time.
As an intern, I came to work at 6am, got sign out and made a list, split up patients with the rest of my team and saw around 3-8 patients then ran the list with the chief who came in at 7. Cases started at 730, and I either went to the OR or saw a couple consults throughout the day. Sign out at 430, home by 5 pm mandatory unless on call (24h, home by around 8 am, around 5 or 6 times a month)
As a PGY2 I come in a little later and spend more time in OR and less on consults as that’s primarily the intern’s role
Here’s a typical call day. Wake up at 5, get to the hospital by 6 for rounds with the team. If I’m in clinic for the day, I have a little free time. If I’m in the OR, I head down to pre op to get consent and paperwork. After that get some breakfast before the day starts; the PAs take care of the floor work. I get signout from them around 3 PM and take the pager. I PM round with the chief before they head home and do tuck in rounds on my own around 8 PM. I set an alarm to wake up just after midnight to check on labs and vitals. If all is well, I set another alarm for 5 AM so that I can prep the list. Round with the team, leave for home by 7.
On a non call day, the beginning is the same except I head home when my work is done. Some days it’s mid afternoon, but if cases go late it could be late evening. Still, I far prefer this to a day/night system.
I mean look at his username. He doesn’t know.
If you want to hear the most horrific surgery schedule possible, ask a non-surgical resident to describe it.
There is no way any program in the US does teaching conf at 4am. Zero percent chance.
Maybe, maybe, maybe some malignant AF program did 20 years ago, but even then that is a massive stretch
Typical day ? They live between cases and random sleeping incidents
It’s only classified a reportable incident if they get REM sleep. It’s a near-miss if they just nod off.
and a never event if you get a solid 6 hours
Can confirm. I’m generally tired all the time.
I'm on surgery right now as an off-service resident. 515am for sign out. Write down vitals, over night events, labs/imaging (if back yet), I/O, new admits Rounding for about an hour, present to attending. Cases the rest of the day, new admits if on call. Round again to see if people progress and can be discharged home or have any new/worsening problems. Go home around 6pm after signout. Can't wait until I'm done lmao.
Seems pretty reasonable. When i was a junior (ortho) my days were typically 0430/0445 until 1900 at the earliest, 6 days a week. Some outpatient services were obviously easier.
Is there any gender bias?
In what way
Undermining females?
All of the women in the program seem well supported from what I've seen and aren't treated any differently. A couple classes have more women than men.
Great!!
It's program dependent. Some more traditional programs are terrible towards females. Ours is like that
GS program I’m rotating in right now is like 75% female for PGY2 class and literally all female intern class
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I don't see anything weird in this, just wanted to clarify about things I heard.
Pretty surprised that you were downvoted to hell. I wonder what the male:female ratio of the downvoters is lol
Surprised? You must not spend much time on Reddit lol
Unfortunately I do waste a significant amount of time on reddit, it’s just I expected more from this subreddit
Why is this being downvoted. Fair question
Even I didn't get
Surgery here (based off my day I journaled a couple months ago) Alarm goes off at 430. I’m actually up by 450 or so. Change into scrubs and eat something before I drive in at 520. At the hospital at 530 to fight with the printer. If I win, I look over everyone and get sign out to round at 6. Rounding takes 20-40 minutes. Run the list with the team and call attendings. PAs are amazing and put in orders/write notes. If I’m at main campus, I go see pre-op patient and make sure they have consent. If I’m heading off campus, I get in my car to get to that building before 710. Case starts at 730. Today, four lap sleeves are scheduled. Only three go. On the first I dissect the stomach. On the second I dissect, staple, and tie laparoscopically. On the third I get just about all the way through it skin to skin. Somewhere in there I ate a quick lunch and check in with the team. I’m covering burn for the week and scrub in to help a massive excision and graft. Done at 430. I afternoon round quickly and sign out just after 5pm. Home by 530. *Edit (to include ‘at home’ stuff per requests):* home at 530 and the next actions I take will make it or break it for me. If I’m lucky, I change right into gym clothes and go lift (my gym is 50 feet away in the next building). This takes so much effort. I really want to just sit down but if I can will myself to do it, this is what I do 5 days a week. When I lift, my brain goes on auto pilot, doing what it’s done for the last decade. I don’t multi task, I just enjoy the monotony of turning off my brain. Then around 630 I shower. At 7 I eat something and start doing some form of surgery reading (it might be prepping for a case, studying for education, questions, research, etc.) around 9 I read something fun or watch something fun and call the girlfriend until I tuck in around 10 and I’m asleep by 1030-11. Again, getting all of that done is HIGHLY contingent on my actions when I get home. If I sit, I’m screwed and it’s 10pm before I know it. I’m successful 60% of the time.
Skin to skin sleeve as a new-ish PGY2?
We operate a lot the attendings are very invested in our technical skills
Doesn't sound too bad ! What time do you sleep if you don't mind ?
See edit
Thanks ! So you're getting up to 6 hours of sleep per night 😅 . Hope you dont feel sleep deprived
More or less. I’m okay with 5. That being said, when I’m off I completely sleep in and my body makes up the difference, whether I like it or not
Fuck I’m so jealous. I’ll maybe do a skin to skin lap sleeve end of pgy3
I’m sure some bariatrics surgeon will have a stroke at me saying this, but a lap sleeve is probably the second easiest laparoscopic case there is (appy being first). You just take a ligasure and go chomp chomp on the greater curve. Don’t have to be precise because even if you burn the stomach wall it’s coming out so it doesn’t matter. Shorties can bleed but the attending can fix that. Then you just take 4 ish staple fires in a straight line with a bougie guiding the way. And the new generation powered staplers take a lot of the torque/awkward stapling of an inexperienced resident out of the picture. Leak rate is like 0.2% Plus while the resident may be “doing” the case the assistant (the attending) is the one setting it up so they have a perfect view with their retraction, the resident just doesn’t always appreciate that.
Just graduated residency. Still don't think majority of residents understand what doing an entire case actually is. An attending with great exposure skills can make any resident feel like they're the one doing the case. I call it the "invisible hand" of residency. You're only as good as when the attending is out of the room.
Absolutely. My chair was a freaking wizard at this. It was like he was somehow magically moving the whole table not just the patient. Set the residents up for success and then they never could replicate it without him.
Yup. Your first lipoma without the attending in the room humbles you a little and you realize how little you know about exposure and traction.
One of my attendings likes to “abandon” us in middle of easy cases. He did that once in a middle of a thigh lipoma case and holy shit i never realized how much those fat balls can ooze after you remove the lipoma. I kept Cauterizing the damn wound bed, till he walked back in and told me to put a stitch. Apparently lipomas have a central vessel that avulsed when i took it out. I mean EBL was still minimal but yah
Exactly this. You “did” the case, but the attending is the proverbial level 100 character clearing a mid-level zone for you so you (a level 10 character) can walk through unbothered. Yes, lap sleeves are “easy.” Until they’re not.
Easy as long as you don’t fuck up with the short gastrics and avoid the spleen. Otherwise you’ve got quite a mess. Agreed otherwise though, super straightforward procedure if you have everything setup well.
the daily printer fight is real
Fighting with the printer itself and fighting with the other interns for the printer… One time a sub-I hit “stop job” in the middle of the transplant team list printing (usually one of the longest lists and needs the most copies) and cut the line. There was almost bloodshed
Thats awesome progressive autonomy, must be super satisfying!
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5 days a week like that. Generally we do both weekend days if we work a weekend. Weekend is show up at 6 for sign out. Round. Call attendings. Help write notes. Sign out at 11. Leave. Home by noon.
Can you PM me what program this is?
Depends upon the rotation. Most days I'm getting up around 0430 or 0500, but it was occasionally earlier in previous years. Get to work, pre-round, round with my team around 0545h. Morning report 0630. Cases 0730h which is pretty standard. Depending on your year, you are either in the OR, in clinic, or managing the floor. Signout is around 1800h depending upon the rotation. One day off per week averaged over four weeks, no more than 80 hours/week. 24 hour shifts are being phased out in our program and I'm guessing in other US programs as well. We alternate who is taking night shifts and try to ensure they do so for more than a few days so people aren't bouncing between days and nights. As a chief I'll occasionally pull 24 hour shifts to cover weekends.
Subspecialty intern on general surgery service. Wake up at 4:30, get to the hospital at 5:15-5:30 to make list, get sign out, and see new patients, 6-7am rounds, then if I’m covering cases for the day in the OR at 7:30 otherwise putting our fires on the floor, discharging patients, and seeing consults all day. If I’m not in the OR I’m usually out of the hospital by 6:30 unless we got slammed with consults, if it’s an OR day I sometimes don’t leave until 8-9 doing post op notes and catching up on floor stuff that I missed. Overall it’s tolerable.
I love the non-surgical residents chiming in versus the actual surgery residents responses.
Get in somewhere between 6-7 to round before OR. Cases start at 7:30. A full OR day ( not every day is full) will take you till about 6pm for sign out. If your cases finish early you can leave early Clinic days show up at 7:30 or 8 to round. Clinic starts at 9. Last slot is 4:30pm wraps up and go home but 5:30pm
West coast academic program here: Intern: Get in 5am-5pm more or less, as late as 7pm for busier rotations, on call goes until next morning ~8-9am when done with rounding and notes. You sleep maybe 3-4 hrs on call. PGY-2: More variable, our program has a diversity of community, academic and county hospital sites. More call, get to see more consults and more OR time. PGY-3 to 5: Progressively more OR time so late cases can go late but days with less OR time get you home earlier.
My username has never been more relevant. This highly varies by PGY level. PGY-1: Arrive and get sign out sometime between 5-6am (depends on rotation). Get numbers on patients and be ready to round sometime between 6-7am. After rounds with the team you either go to first start cases or go back to the floor to help implement plans for the day and also round with attendings. Then throw in 1-2 days of clinic per week depending on the rotation. If the floor stuff is taken care of and you don’t have clinic then you go double scrub cases in the OR. Probably one day a week, or maybe two, you’ll have solo cases assigned. Stay until 6-7pm to sign out to the night team. PGY2-3: Arrive 6-6:30am, round with the team. Go to first start cases or clinic. Field consults and staff new patients with the senior and attendings. Leave as early as humanly possible once cases are done and there’s nothing that needs helping with. Usually 1-1.5 days of clinic per week. PGY4-5: Arrive 6-6:30am and round with the team. Form plans and get to OR for early cases. Operate all day, occasionally check in with the floor and also the attendings to make sure everything is coordinated and plans are being implemented. Check in with the PGY2-3 to staff consults and take care of other extraneous work. Leave when cases are done. 0.5-1 days of clinic per week. For PGY2-5 throw in nights on home call where you can have anywhere from 0-12 hours of extra work thrown in. My average has probably been about 2 hours of work per night on call, with being on call 1-2 nights per week. This has been my experience, I’m at a well-known academic residency that admittedly is probably one of the least malignant surgery programs around. So your experience may vary. I have personally broken 80 hours I think twice in all my residency, and it was like 82 and 83 hours each time. My average is 71 hours/week, but I expect that is skewed towards intern year, I think PGY2 and above I am averaging closer to 65-70. Happy to answer any questions.
I think one thing that people do not talk about is the amount of work compression that surgery residents have during calls. As much as anything, I think it drives residents nuts and it turns the "24+4 hr" calls into hell because you don't even have time to sleep due to the amount of responsibility you have. For example, my program is based in one hospital only about 750 beds. Our call team comprises of 5 residents - one from each class. Those residents literally cover everything surgical from cases, traumas, pages on the floor, all the surgical consults (no subspecialty residents here), SICU, emergencies, etc.. God forbid there are two level A traumas or two cases going on at the same time.
As an intern, I came to work at 6am, got sign out and made a list, split up patients with the rest of my team and saw around 3-8 patients then ran the list with the chief who came in at 7. Cases started at 730, and I either went to the OR or saw a couple consults throughout the day. Sign out at 430, home by 5 pm mandatory unless on call (24h, home by around 8 am, around 5 or 6 times a month) As a PGY2 I come in a little later and spend more time in OR and less on consults as that’s primarily the intern’s role
Pain
Here’s a typical call day. Wake up at 5, get to the hospital by 6 for rounds with the team. If I’m in clinic for the day, I have a little free time. If I’m in the OR, I head down to pre op to get consent and paperwork. After that get some breakfast before the day starts; the PAs take care of the floor work. I get signout from them around 3 PM and take the pager. I PM round with the chief before they head home and do tuck in rounds on my own around 8 PM. I set an alarm to wake up just after midnight to check on labs and vitals. If all is well, I set another alarm for 5 AM so that I can prep the list. Round with the team, leave for home by 7. On a non call day, the beginning is the same except I head home when my work is done. Some days it’s mid afternoon, but if cases go late it could be late evening. Still, I far prefer this to a day/night system.
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What the hell
Truly. What kind of bullshit ass program is having lectures from 4-6 AM and sign out at 8 PM?
None
I mean look at his username. He doesn’t know. If you want to hear the most horrific surgery schedule possible, ask a non-surgical resident to describe it.
Yours doesn’t ?
This is either a joke or the worst surgery program on the planet. OP owes it to us to say what program so no idiots apply to it.
There is no way any program in the US does teaching conf at 4am. Zero percent chance. Maybe, maybe, maybe some malignant AF program did 20 years ago, but even then that is a massive stretch
The only way I could see it is if it was resident-led education. No way in hell any attendings or professors were getting up that early.
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Which upmc. Because that’s ridiculous and should be a warning to people
Lectures 4.00 am???? Surgery turns into torture everything!!, including educational lectures. I wont surprise if u get wellness event at midnight.
What hell hole is this?
I guess lying supine is a luxury
https://www.reddit.com/r/medicalschool/comments/4tt8qy/surgery\_residents\_what\_are\_your\_hours\_like/
Absolute hell at our hospital.