Thank you for this talk. I recently joined my residency educational development group (current junior resident) as we try to adapt our surgical curriculum given all our OR time restraints and losing important intraoperative experience. Lots of food for thought and much progress to be made since I keep hearing the same arguments over and over again without much headway or building of windmills so far. Appreciate the time making this presentation.
Thank you for watching. I hope that somewhere out there, this video (or at least, this logic) will reach someone who matters and can create some positive change.
Wow. As a longtime fan of the channel, this one hits closer to home than any of your other videos I've ever seen. I had so many thoughts bubbling up throughout watching it; I've tried to condense them. On part 1: Really glad the video touched on this and lightly pushed back on the prevailing attending narrative. If current trainees are worse, it's because there are now three types of chole to master instead of one, and our attendings let us do less and keep us out of the OR doing their charts. Plus we have to lie about our hours, and then get told by those same attendings who made us lie that "well you only worked 80 hours this week, back in my day we worked 90, so stop complaining!" even if you actually worked 100 hours that week! I love most of the attendings but they all have this ridiculous blindspot to their hypocrisy and how quickly their narratives about current trainees crumble with just a hint of critical thinking. On part 2: I won't bore you with my trauma dumping on this, but you hit the nail on the end. The "top school" students benefit from these changes and the rich get richer. Hmm, I wonder which schools have better representation in the AAMC? On part 3: I think I've heard this idea in one of your past videos, and while I love the idea, I'm not so sure it would work; students are already doing this. I wasn't alone in pushing my school admin to bring back something, *anything,* to stratify us...ultimately I think they are optimizing to have a high match rate, rather than to help the most motivated students match well. And the best way to help your bottom 5% students match is to throw your top 5% under the bus and get rid of objective things. Using the "you are hurting us" rhetoric you mention hasn't been effective, because they already *are* hurting us, and they don't care. To get rankings back you would really need to get every specialty on board, and even then who knows if they'd change...
Thank you for such a thoughtful (and kind!) comment. RE: your third point… I’m a believer. Schools need someone else to be The Bad Guy. And there’s no better Bad Guy than surgical program directors. It would take persistence, and there would have to be an observable benefit in Match success for whatever metric or experience the PDs say they want. But I think markets work, and even the residency selection market can work in this way. And you’re right - I’ve presented this thesis before, though I dressed it up very differently. e.g., here: The Residency Selection Arms Race: How Orthopedic Surgery PDs can Transform Medical Education youtu.be/ Thank you for watching!
@@sheriffofsodium Thank you! My optimistic side does hope that's true, and hopefully we start seeing change slowly but surely! Either way I'll be eagerly awaiting the next vid. Come join us in the OR (scrubs and everything!) sometime I promise we aren't all crazy 😂
Thanks Dr. Sheriff. Been watching your videos since the beginning of my second year in school and am about to begin clerkships. This feels especially relevant given I’m surrounded by a constant need to do the checkbox activities to get competitive for residency apps. Regardless of how it affects the optics of my competitiveness, I hope to keep pursuing alternative activities in school and extracurriculars that improve my skills as a future physician, rather than just doing these things to look good for a single moment in my life and never reflect on again. Hopefully by the time I’m applying, those activities might make the difference.
Well it is a fact that training has just gotten pushed back at every level. Shadowing to med school, assisting in surgery to residency, leading surgery to fellowship. I totally agree that the way to combat this is just let people learn.
This is really interesting, thank you! I know you've recommended something similar in previous videos, leveraging the willingness of medical students to do what it takes to match and using that to shift focus towards more meaningful or useful differentiating factors, and the argument works just as well here IMO. Deciding exactly how things should play out is going to be tricky, but at least this gets the conversation started! I'm curious what sort of reaction/questions you got at the ACS meeting. Did you feel like participants were willing to engage with these ideas? Thank you again!
Thank you - and you’re right, my goal for this talk was to get the conversation started. You’re also right that I’ve pitched this general idea before - e.g., here: th-cam.com/video/1hzOwSk0Ryk/w-d-xo.htmlsi=C0gicq-3pLecnFEB But I try to design a new talk for each audience - so I tried to conceal the thesis in an entirely new conceit. As far as how it was received… I think well. But my perspective may be influenced by selection bias of who wanted to talk to me afterward.
I would say “good” - but it’s always hard for me to judge. There’s a positive selection bias in who wants to talk to you afterward - most folks who are mad don’t care to hear from you any more.
@@sheriffofsodium It’d be very helpful for just a few PDs who take an initiative to implement selection strategies as you outlined, and that may kindle a paradigm change in US residency programs.
What your insinuating is moving towards competency based training/evaluation. Medical students should no longer just be passed along because they pass tests and check boxes but rather because they meet objective measures that assure better patient outcomes. The same is true for residency training. Unfortunately this problem is not necessarily unique to surgery and nobody has really addressed this problem
Agreed. Competency-based training is educationally logical but creates obvious staffing/scheduling issues. If residency were a primarily educational - rather than service-oriented - endeavor, this might have been fixed long ago.
Great video as always. The graphic you put up about the MSPE leaves me wondering, since I just saw it as another box to check off in residency applications. What's the point of the letter if there are no metrics mentioned in it? It's not like the dean of a school can reliably give a strong qualitative endorsement of 100-300 students reliably.
Deans letter without metrics could add qualitative comments from clerkship rotations and can also have info that explains if any disciplinary actions or remediations were taken or not. basically can speak to professionalism and have comments from faculty in clinical rotations. I think there should be some metrics in there that state what quartile the student was in or other ways programs can assess the students relative performance in their med school class.
Well, the MSPE does begin with a few bulleted noteworthy characteristics about the applicant. But those are generally written by the applicant themselves. These days, many schools simply compile and report (verbatim) statements from the rotation evaluations. It’s not very helpful to programs - but it’s defensible and leads to fewer student complaints/challenges than if the dean were to make a more subjective summary. By the way, I did cover that paper in a previous Journal Club if you’re interested: Journal Club: Comparative performance data in the MSPE th-cam.com/video/XiH6y5D4rQM/w-d-xo.html
@@sheriffofsodium thanks for the reply, I’ll give that one a listen. My school also asked me to write some bullet points for my MSPE which is I’m skeptical about it’s value to PDs, especially compare to just copypasting clerkship evaluation comments. I respect that the PDs definitely have a tough job, especially with the volume of applications. I wonder, if you gave applicants an optional essay/short response if that could be a useful tool to PDs. Maybe focused specifically on hardships/circumstances during school, so every single applicant doesnt feel compelled to submit something just because.
I mean, I guess they kind of are podcasts… I just like to have some visual aids. But I don’t have any illusion that my audience wants to actually see me - so I don’t necessarily need a video format otherwise. I’ve thought about trying to do a regular podcast but just don’t have the bandwidth to do everything… and I feel like the audience here is growing (and I’m reaching some of the people I want to reach).
Anecdotally, I see more complications in younger surgeons than older ones. Clipping CBD's, nicking arteries, more frequent return to OR. It's pretty bad.
Shouldn’t surprise you unless you’re saying the older ones objectively didnt have those when they were younger… in which case I’d say - show me the data.
I just want to say that i really appreciate your videos, they're well informed and academic but you're not afraid to call out bs when you see it.
Thank you for taking the time to watch.
Thank you for this talk. I recently joined my residency educational development group (current junior resident) as we try to adapt our surgical curriculum given all our OR time restraints and losing important intraoperative experience. Lots of food for thought and much progress to be made since I keep hearing the same arguments over and over again without much headway or building of windmills so far. Appreciate the time making this presentation.
Thank you for watching. I hope that somewhere out there, this video (or at least, this logic) will reach someone who matters and can create some positive change.
Wow. As a longtime fan of the channel, this one hits closer to home than any of your other videos I've ever seen. I had so many thoughts bubbling up throughout watching it; I've tried to condense them.
On part 1: Really glad the video touched on this and lightly pushed back on the prevailing attending narrative. If current trainees are worse, it's because there are now three types of chole to master instead of one, and our attendings let us do less and keep us out of the OR doing their charts. Plus we have to lie about our hours, and then get told by those same attendings who made us lie that "well you only worked 80 hours this week, back in my day we worked 90, so stop complaining!" even if you actually worked 100 hours that week! I love most of the attendings but they all have this ridiculous blindspot to their hypocrisy and how quickly their narratives about current trainees crumble with just a hint of critical thinking.
On part 2: I won't bore you with my trauma dumping on this, but you hit the nail on the end. The "top school" students benefit from these changes and the rich get richer. Hmm, I wonder which schools have better representation in the AAMC?
On part 3: I think I've heard this idea in one of your past videos, and while I love the idea, I'm not so sure it would work; students are already doing this. I wasn't alone in pushing my school admin to bring back something, *anything,* to stratify us...ultimately I think they are optimizing to have a high match rate, rather than to help the most motivated students match well. And the best way to help your bottom 5% students match is to throw your top 5% under the bus and get rid of objective things. Using the "you are hurting us" rhetoric you mention hasn't been effective, because they already *are* hurting us, and they don't care. To get rankings back you would really need to get every specialty on board, and even then who knows if they'd change...
Thank you for such a thoughtful (and kind!) comment. RE: your third point… I’m a believer. Schools need someone else to be The Bad Guy. And there’s no better Bad Guy than surgical program directors. It would take persistence, and there would have to be an observable benefit in Match success for whatever metric or experience the PDs say they want. But I think markets work, and even the residency selection market can work in this way.
And you’re right - I’ve presented this thesis before, though I dressed it up very differently. e.g., here:
The Residency Selection Arms Race: How Orthopedic Surgery PDs can Transform Medical Education
youtu.be/
Thank you for watching!
@@sheriffofsodium Thank you! My optimistic side does hope that's true, and hopefully we start seeing change slowly but surely! Either way I'll be eagerly awaiting the next vid. Come join us in the OR (scrubs and everything!) sometime I promise we aren't all crazy 😂
Thanks Dr. Sheriff. Been watching your videos since the beginning of my second year in school and am about to begin clerkships. This feels especially relevant given I’m surrounded by a constant need to do the checkbox activities to get competitive for residency apps. Regardless of how it affects the optics of my competitiveness, I hope to keep pursuing alternative activities in school and extracurriculars that improve my skills as a future physician, rather than just doing these things to look good for a single moment in my life and never reflect on again. Hopefully by the time I’m applying, those activities might make the difference.
Unrelated to the topic of the video but, I love how you stick to one aesthetic in your presentations. It's like a brand.
Well it is a fact that training has just gotten pushed back at every level. Shadowing to med school, assisting in surgery to residency, leading surgery to fellowship. I totally agree that the way to combat this is just let people learn.
This is really interesting, thank you! I know you've recommended something similar in previous videos, leveraging the willingness of medical students to do what it takes to match and using that to shift focus towards more meaningful or useful differentiating factors, and the argument works just as well here IMO. Deciding exactly how things should play out is going to be tricky, but at least this gets the conversation started!
I'm curious what sort of reaction/questions you got at the ACS meeting. Did you feel like participants were willing to engage with these ideas?
Thank you again!
Thank you - and you’re right, my goal for this talk was to get the conversation started.
You’re also right that I’ve pitched this general idea before - e.g., here:
th-cam.com/video/1hzOwSk0Ryk/w-d-xo.htmlsi=C0gicq-3pLecnFEB
But I try to design a new talk for each audience - so I tried to conceal the thesis in an entirely new conceit.
As far as how it was received… I think well. But my perspective may be influenced by selection bias of who wanted to talk to me afterward.
A very thoughtful presentation… what were the reactions from the attendees of the state ACS ?
I would say “good” - but it’s always hard for me to judge. There’s a positive selection bias in who wants to talk to you afterward - most folks who are mad don’t care to hear from you any more.
@@sheriffofsodium It’d be very helpful for just a few PDs who take an initiative to implement selection strategies as you outlined, and that may kindle a paradigm change in US residency programs.
excellent presentation. any data about differences between the 77% and 23% ??
What your insinuating is moving towards competency based training/evaluation. Medical students should no longer just be passed along because they pass tests and check boxes but rather because they meet objective measures that assure better patient outcomes. The same is true for residency training. Unfortunately this problem is not necessarily unique to surgery and nobody has really addressed this problem
Agreed. Competency-based training is educationally logical but creates obvious staffing/scheduling issues. If residency were a primarily educational - rather than service-oriented - endeavor, this might have been fixed long ago.
The Sheriff is in town😬😬😬
Great video as always. The graphic you put up about the MSPE leaves me wondering, since I just saw it as another box to check off in residency applications. What's the point of the letter if there are no metrics mentioned in it? It's not like the dean of a school can reliably give a strong qualitative endorsement of 100-300 students reliably.
Deans letter without metrics could add qualitative comments from clerkship rotations and can also have info that explains if any disciplinary actions or remediations were taken or not. basically can speak to professionalism and have comments from faculty in clinical rotations. I think there should be some metrics in there that state what quartile the student was in or other ways programs can assess the students relative performance in their med school class.
Well, the MSPE does begin with a few bulleted noteworthy characteristics about the applicant. But those are generally written by the applicant themselves. These days, many schools simply compile and report (verbatim) statements from the rotation evaluations. It’s not very helpful to programs - but it’s defensible and leads to fewer student complaints/challenges than if the dean were to make a more subjective summary.
By the way, I did cover that paper in a previous Journal Club if you’re interested:
Journal Club: Comparative performance data in the MSPE
th-cam.com/video/XiH6y5D4rQM/w-d-xo.html
@@sheriffofsodium thanks for the reply, I’ll give that one a listen. My school also asked me to write some bullet points for my MSPE which is I’m skeptical about it’s value to PDs, especially compare to just copypasting clerkship evaluation comments.
I respect that the PDs definitely have a tough job, especially with the volume of applications. I wonder, if you gave applicants an optional essay/short response if that could be a useful tool to PDs. Maybe focused specifically on hardships/circumstances during school, so every single applicant doesnt feel compelled to submit something just because.
Incredible!
Thank you for watching.
love your videos
I really appreciate you taking the time to watch my stuff.
Do you release these videos as podcasts?
I mean, I guess they kind of are podcasts… I just like to have some visual aids. But I don’t have any illusion that my audience wants to actually see me - so I don’t necessarily need a video format otherwise. I’ve thought about trying to do a regular podcast but just don’t have the bandwidth to do everything… and I feel like the audience here is growing (and I’m reaching some of the people I want to reach).
surgical education presentation (sherrif's version)
Anecdotally, I see more complications in younger surgeons than older ones. Clipping CBD's, nicking arteries, more frequent return to OR. It's pretty bad.
Shouldn’t surprise you unless you’re saying the older ones objectively didnt have those when they were younger… in which case I’d say - show me the data.