Neurosurgery and pediatrics are two very different rotations, especially when it comes to teaching. At Children’s Memorial Hospital, there are two hours (8am and 12pm) reserved every day for resident teaching. There are signs at every nursing station that remind them not to page during those hours unless it is absolutely urgent. The sessions are set up for case discussions and they focus on the important, relevant points of diagnosis and management. It was set up so that I could contribute and not feel stupid (even though I never did).
On neurosurgery, there are four conferences each week that students are required to attend. Two of them are for residents only, with presentations given by either attendings or fellow students. The topics themselves can be fascinating, but they often cover very specific details that are irrelevant for students rotating through. The latest conference I attended was nothing more than an overzealous attending and a 90-minute pimping session. Even if I knew an answer, there was no way I would offer it up, because the resident who didn’t know would probably feel insulted and proceed to make the rest of my rotation miserable. The other two meetings essentially consist solely of attendings arguing over the minutiae of rare and complicated cases and their surgical plans while the residents answer pages or stare at their phones for the entire duration.
On pediatrics, this constant learning mentality extends into the resident-student interactions as well. The residents took the time out to give us lectures, review cases, and quiz us. If anything, they were afraid that they were spending too much time teaching us. The first day on my inpatient infectious diseases service, the chief resident took me and my teammate aside, told us how the computers worked and where to find important information, printed out flow sheets for us to use, gave us advice on how to present, explained the team dynamics and roles, and made us feel welcome.
On my neurosurgery block, I blundered around my first day feeling ignored. No one seemed to care that I was there until I got in their way. After following them around on rounds not really knowing what was going on, I found a friendly face to scrub in with. By the end of the day, I had no idea what my roles or responsibilities were, how I could help out, or what kind of information I was supposed to learn from my rotation. It wasn’t until the end of my first week that I started feeling comfortable and part of the team.
It’s no mystery that I feel like pediatrics got it right and neurosurgery got it wrong. There is an inherent problem with how “teaching” occurs in neurosurgery. Everyone is always expected to know everything about neurosurgery before the rotation begins or even before their residency begins (except maybe the finer details of management, which you can argue about once you’re an attending). If you don’t know the answer, you feel embarrassed and study furiously after you get home from working for 14 hours. There really is no teaching; there are only unrealistically high expectations. As I was watching the train wreck that was one resident’s attempt at a logical answer to a question, I couldn’t help but think to myself how much more effective it would have been if they had just taught it first.
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