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Getting Caught Unprepared

IconPin-Chieh Chiang -- It was the last week of my first General Surgery rotation, and in fact the last day of surgeries that I would be scrubbing into for a while. There’s never a good excuse for showing up unprepared, so I won’t give one, but the bottom line is I didn’t read up on the surgeries for the day. Somewhere in the back of my mind I was hopeful that my preceptor wouldn’t notice. I only thought this because he never really asked many questions before. In retrospect, my preceptor would always ask one or two questions and when he realized that I had done my homework, he would leave me alone.

This time, it was pretty obvious that I had not done my reading and he smelled my uncertainty. With both my hands holding onto retractors and my legs getting numb from fear and standing all day, I had to make a quick decision. Do I lie and try to swim my way out of this one or just tell the truth and sink? To be honest, I just can’t lie. Plus at that moment, I didn’t feel very confident in myself that I could be saved either way. So I told the truth once again hopeful that he would let me go for being truthful.

I had no such luck. My preceptor was not going to left me off the hook. He drilled me into the ground. I literally felt like I was buried. He even made a point to say, “Because you’re not prepared today, I’m going to make you sweat.” Let’s just say at the end of the surgery I felt too beaten to follow him out like I usually did before. While I stayed by the patient, the anesthesiologist, the anesthesiologist’s student, and the scrub tech all took turns consoling me.

There were many things about the experience that made me want to hang my head in shame; realizing I had not read and was caught by my preceptor, not being able to answer his questions intelligently, and knowing that three people had witnessed this event. However, I think the worst part about the whole experience was in the end when my preceptor was closing. He said, “I was going to let you close, but because you didn’t come prepared, you just lost the privilege.”

To end on a positive note, this was just one of the many valuable lessons that I learned on this surgical rotation, which I thoroughly enjoyed. Like how Ali put it – “Surgery is addictive!”

September 14, 2007 | Permalink


Hi Pin-Chieh,I wanna add another positive point though it may sound silly,u know I'd be very glad if in my 2nd year of medicine any preceptor payed this much attention to my being prepared or not.Wish u luck.

Posted by: Innocence_e1 | Sep 17, 2007 2:41:05 PM

i want to console you too,because it's a bad experience that you were caught by your preceptor while you werenot ready.i was looking such stage when happened for my classmate.but he was calm and didn't show any reaction.i really admire him.i think overall,being unable to answer the preceptor is common.it sometimes occure between my classmates.i also believe if such experience don't happen,we won't be good doctors. because although we study hard,the attendings may ask some questions that we don't think it may be noticable.

Posted by: sara omidi | Sep 18, 2007 3:45:03 AM

Well you made me glad I didn't go to your medical school, or maybe it was just because he wasn't hugged enough as a child :)

Posted by: Mark | Sep 18, 2007 1:55:25 PM

I am a preceptor in a health care program. I do the same as your preceptor did. In the end we want you to learn and realize that little things, in health care, always count. I'll forward this to my interns and students. BTW, I was hugged a lot as a child...

Posted by: Angel | Sep 18, 2007 5:45:37 PM

Sounds like harassment to me.

Posted by: | Sep 18, 2007 7:00:22 PM

sounds like harrassment to me too! shame based education is malignant- I think in general most medical students at some point run into the attending who rarely teaches and then at the end blames the student for being "unprepared". Most students "pay" for the privilige of teaching themselves by preparing with these folks and the preceptor adds little....The best preceptors reward and encourage self study, REQUIRE active participation and motivate srudents to learn without shame or insults. Are we training navy seals or compassionate physicians?

Posted by: jj | Sep 18, 2007 8:07:27 PM

Well, you'll never do that again. As bad a teaching method as it is, people don't forget being made to feel like an idiot and you will never make the same mistake because of it. It works.

Posted by: brian | Sep 19, 2007 6:36:09 AM

Not harassment. Clinical responsibility. This is essential to learning. I do not berate my interns, and never in front of a patient. I do call them aside and question them to make them realize their mistakes. Clinical ineptitude must not be tolerated. When will you become proficient? After graduation? In our litigating society, this is detrimental. Professional liability insurance is sky rocketing due to the enormous amounts of claims,and sadly enough, warranted claims. I agree there must be a balance of rewards and penalties, but you cannot be very encouraging when a patient's health is at risk.

Posted by: Angel | Sep 19, 2007 7:08:13 AM

i am doing general practitioner block now. had a video recording session review today with 4 other colleagues and a GP. Feel like want to hang my head in shame, really. Besides not being able to speak as fluently as the locals, my knowledge is just-so-shallow. nevertheless, it is always better to know my weaknesses now than later. cheerio :) study hard!

Posted by: jessie | Sep 19, 2007 10:08:05 AM

I soooo know what ur talking about. I am just in last semester of second year (learning neuro, endo and psy). Because we're PBL system, so sometimes there will be clinical attachments. It so happens my clinical tutor is the head of neurology in the hospital,and he asks lots of questions.I always feel really embarrassed when I could not answer any questions...eventhough so far he din comment on my ineptitued or anything like that...
To me, the kind of tutor who gives u a hard time (either because he hates you, or simply being his strict, no nonsesnse self) is the most memorable one. That kind of teacher always end up being a good teacher to me...because I would actually study and make sure I know everything.
I am the sort of lazy person who don't study unless threatened, lol. So that kind of tutor work wonders for me, lol.
But yeah, it could be embarrassing.

Posted by: Afiza | Sep 19, 2007 12:27:23 PM

I think it's chance for making your level to the best and maybe challenge that preceptor someday.

Posted by: Bishoy | Sep 19, 2007 1:28:10 PM

Going to my medical school has nothing to do with my general surgery preceptor. He's not a regular core preceptor, though he occasionally takes a couple students from my school. If you read back a couple entries - I had problems scheduling a general surgery rotation. And I feel very lucky that he was willing to take me on. It's actually been my favorite rotation so far. I got to participate in a lot of first assists and he taught me several techniques on suturing. If I got lectured for showing up not prepared, well I pretty much deserved it.

Posted by: Pin-Chieh | Sep 19, 2007 9:23:21 PM

I also sometimes go to duty unprepared... However, it is already our responsibility to do our tasks and do our best on it... Preceptors would also want their subordinates to be well prepared... Knowledge is needed in order to attain a skill. Many say that, how can you improve a skill if you are not even knowledgeable about it. However, your preceptor may want you to be more efficient in your work for your own future responsibilities. And I congratulate you for being honest eventhough you may have been afraid to tell the truth. Your experience has been a lesson to you and to the readers of your article as well... Good Luck =)

Posted by: Prelyza | Sep 19, 2007 10:18:43 PM

No pain no gain!

Posted by: Emily | Sep 19, 2007 11:18:19 PM

hey pien! im a nursing student here in the Philippines and i am pretty much aware of the things that happen inside the OR during my rotations, especially the part where the preceptors ask the interns/resident doctors about stuffs that are related with the surgery that they are doing. All i can say is that let that experience be a lesson, and keep in mind that all the great doctors started as what you are now. Let this bump in the road give you a little joyride.

That's all!

Posted by: Eva Marie | Sep 21, 2007 9:03:06 AM

Hey Pin-Chieh (by the way, I love your name!). God, I totally understand how you feel. I did the same thing one time whilst on my General Surgery rotation and, damn, my preceptor slammed me. However I can say that, though it was a mortifying and pretty damn scary experience, I'm stronger and smarter for it. It was a stupid thing for me to do to go into a surgery unprepared - afterall, people's lives are at stake in that OR - but I realized that it was unacceptable, and my being yelled at for like a million hours in the middle of the OR toughened me up. Though I was terrified about the next time I'd see my preceptor! But it's over now and I earned from it. I hope you did too. You sound like you're generally an excellent student and I'm sure you'll go on to be an even better doctor. Good luck, honey! x

Posted by: Sarah Lockhart | Sep 22, 2007 5:50:18 AM

I respect your honesty. Hopefully, so does your preceptor. Occasionally, we are all unprepared from time to time. But the person with integrity doesn't lie about it. Good job!

Posted by: Jonathon Wolf | Sep 22, 2007 12:58:48 PM

well, what medical student forget about their hardships in clerkship and internship?.... we all pass through that and remember, even those seemingly intimidating attendings went through this phase :-)

Posted by: ninette_umpa | Sep 22, 2007 9:16:25 PM

Contrary to what an overwhelming majority of these posts are saying, I believe such "teaching by humilation" is utterly counter-productive. Sure, it ensures results and makes the most complacent student sit up and be prepared for "that" particular day. However, this is a very negative and short-term form of extrinsic motivation. For the long-term professional growth and development of a medical professional, preceptors need to develop an innate and instrinsic fascination and motivation with the profession amongst their students. A sense of responsibility and the acquisition of competence follow naturally when one is encouraged, made to understand one's potential and nurtured along. Slackers should not be tolerated but nor should deflating humiliation on the slightest of inadequecies. It takes the fun out of learning and replaces it with fear. I speak as someone who has completed several sub-internships in general surgery and did well in them but left with a bitter taste due to this negative teaching technique.

Posted by: Salman | Sep 23, 2007 2:41:26 PM

im encouraged by your post,here @ ahmadu bello university teaching hospital zaria nigeria we sign log books which are prerequisites for exams. perhaps it will help.

Posted by: agbese almond | Sep 30, 2007 10:38:54 AM

i'm a resident, and i had a few attendings who chose to be rude and humiliate students. i personally think that they do it for kicks. i think that part in your story about "not being able to close up because you lost your privilege" is just silly. i mean, okay maybe he doesnt want you to close because you're not prepared, but he could have worded it better. i know that i was never smarter because i was humiliated. i had a lot of great attendings that asked a lot of questions . . .questions that i did not have answers to . . .and they didn't humiliate me in the process. when i had the attendings that chose to do so, i lost respect for them, and didn't want to learn from them. i think respect is key in this profession. we all need to learn, yes, but not at the expense of making someone feel really bad about themselves. your preceptor should have told you at the beginning, "i think you should have read-and you need to go home and learn this stuff" and still asked all you the same questions, but not in a hostile manner. i know that is how i'm going to be in a few years, when i'm done with my training process.

Posted by: | Oct 1, 2007 11:37:23 AM

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