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Obstacles to Learning

NewannaAnna Burkhead -- Sometimes, no matter hard you try to avoid them, obstacles are presented in the path to learning. Some of these roadblocks are surpassable, and others, depending on how they came to be or who put them there, are not.

I am finishing up my 8-week surgery rotation with 2 weeks on a urology service. I picked urology from the list of surgical specialties because I didn’t know much about it, and because I heard the surgeries were interesting and never too long.

Now almost done with urology, I have learned a lot about the field, and I agree that the surgical cases are cool. However, there is one attending on the service who has created, in my opinion, some roadblocks to learning for me.

First of all, I get the sense that having a medical student is a nuisance to him. He has, on several occasions, "pawned me off" to nurses or PAs. Of course, I can learn from nurses and PAs as well, but I am supposed to be learning from him, and feeling bothersome is not fun.

Also, he often enlists me to do paperwork. In this regard, I feel helpful, and I don’t want to seem ungrateful for a learning experience in the "red-tape" aspect of medicine, but while I am doing paperwork, he is interacting with patients in a way that would be educational to me. In this way, I am missing out.

The third, and most significant obstacle is the one I’m most disappointed about. Most of the patients on the urology service are men, and most of their clinic visits require genital exams. I thought that spending time in a urology clinic would give me more experience and confidence with this exam, which will certainly be important if I become a dermatologist. However, at the point in the clinic visit when the genital exam is to happen, the attending has a habit of asking me to leave, or taking the patient into another room and shutting the door after them. These are patients with whom I have already had 30-minute conversations, including discussion of urinary and erectile function, so my presence during or participation in a genital exam would have been neither unexpected nor significantly embarrassing.

This is one of the first times I have felt that my presence is a nuisance to a doctor in a clinical setting. It’s also the first time I’ve been blatantly deprived of a learning experience, and I think it’s because I am a female, and a young one at that.

I know that one solution to this problem would be to address my concerns to the attending. Unfortunately, I do not feel comfortable with this option, and with only a few days left in the rotation, I don’t want to rock the boat. So, in my opinion, there’s not much I can do to solve this situation, other than to recommend improvements for next year’s class on my rotation evaluation. Just wanted to share the experience.

April 28, 2008 in Anna Burkhead | Permalink

Comments

Get over being barred from the genital exam...I've been shut out of pelvic exams for 2 years now, because I'm a male - this is despite my earnest expression of interest in being a primary care provider, who on any given day may do several pelvic exams. It is what it is...some people are prudes, and as medical students, we've got to accept it.

Posted by: B | Apr 29, 2008 4:01:32 PM

If you think that's annoying how about being a 24 year old male third year medical student at an outpatient obgyn office with all female attendings for two weeks? I got sent out of the room constantly, especially if the patient was under 40. It was very weird and a thoroughly useless part of the rotation.

Posted by: Grant | Apr 29, 2008 4:03:38 PM

Why do we as medstudents see voicing a legitimate concern as "rocking the boat?" We pay ALOT of money for the education...to expect to be taught is not an unacceptable request.

Posted by: Michelle | Apr 29, 2008 4:29:45 PM

In an ideal world we would be able to sit down and express our concerns to the attending and he would give a coherent and possibly apologetic explanation of his conduct. The reality is, third year is all about being evaluated, constantly and mostly subjectively, and rocking the boat, especially on a surgical rotation, can be grade suicide. It's a pity that the explicit value of giving med students the best possible educational opportunities is so often lost in the tacit knowledge that med students slow you down and get in the way of your normal routine. In urology and OB there is just a better excuse to not accommodate us (and it can legitimately be more awkward). It's a pity, but the time to try to change it is NOT when you are actually in the rotation with your grade on the line. Use your school's feedback system or talk to a dean after the fact about the missed opportunity in the department as a whole (trust me, complaining about a specific attending can come back and bite you if you have any interest in the field).

Posted by: Valerie | Apr 29, 2008 6:54:39 PM

Sure, it is ideal to discuss this with the attending. But, really, of what use would this be? Your comments on the evaluations (be specific if the evals are compiled at the end of the year) may be more useful...or you can directly go to an administrator (you don't have to be specific about individual-be careful). I've done it twice before-one during a rotation and one after the rotation.

Believe me, it will not be the last time. Next time, talk to the attending before the rotation ends. Nothing will change if you don't.

Posted by: John | Apr 29, 2008 7:34:16 PM

Thank you for writing this piece. Its good to hear that its no just male students who are being discriminated against in GYN rotations.

During my 6 week OB rotation I was able to do maybe 10 pelvic examinations, and watch (not even participate) 1 delivery. The story was pretty much the same for the other male student. The female students had a much better experience. Admitedly, a lot (maybe 60%)of times it was the patient who would ask for a male not to be in the room, but the some of the attendings would not allow male medical students to participate.

While I realize both the GYN and male GU exams are personal for the patient, patients need to realize that in the long run they are the ones who are being harmed by having medical students become doctors, without having been exposed to urogenital pathology. And its even worse that senior attendings are not trying to take a more active role advocating for students and allowing this learning opportunity to pass. As a result, in about 1 month I will become a doctor who does not know how to deliver a baby.

Posted by: Laurence | Apr 29, 2008 8:20:36 PM

I have been on the receiving end as a student. Now I am a practising District Medical Officer and I can make a difference. While getting the short end of the stick I used the time to develop my non-clinical attributes. Those have come in handy in my present situation. So much that now my patients are pleased enough to voice how different I am and how down to earth. So try and see how you can generate positives from apparent negatives. Hopefully when you are practising you won't repeat the same mistakes meeted out to you!

Posted by: Lester | Apr 30, 2008 1:32:07 PM

ARGH, what is it with urologists?? On our urology rotation our registrar sent me to buy his sandwiches!!
One wonders... do they start out that way or does their profession make them like that?

Posted by: | Apr 30, 2008 1:32:32 PM

Simply it's about the attending being bored and wanting to finish the day with minimum work, but as long as I'm part of his job, then I'm willing to give him a tough time and fully expose the "obstacle" in his brain cells... if you know what I mean. It can get a little offensive, but, the administration is always there for such cases, reporting early of this attending decreases likely obstacles coming in the rotation. The administration also doesn't want troubling complaints so they'll see to investigating the guy soon.
Your chances are better if you have someone else with the same complaint that decreases time wasted to credit your complaint (it's just about the 'time' but credited anyway). Make sure he doesn't make the obstacle without a price, I mean you don't have to be so cheerful as you was or smiling, not even in a good mood when talking to "the obstacle generator" without spacing yourself away at the same time, and don't forget to focus on the alternative attendings at the same time. This is a 4 month experience with the surgery attendings, I had to be aggressive in a way to learn surgery and gain my own experience in the field.. or else. Good luck with all obstacles.

Posted by: B Cairo | Apr 30, 2008 1:34:38 PM

So what are these Dr's teaching you ? Imaginary medicine? Empathy - no, experiential learning - no, being offhand and useless - maybe..... Most likely, "I had it tough - so you must too". Hmmm that makes no sense at all, yet it goes on like baldness from one generation to the next.

Posted by: Menthoids | Apr 30, 2008 3:49:07 PM

Great article

Posted by: Sujit | Apr 30, 2008 10:33:11 PM

It helped me to study better

Posted by: Splochan | Apr 30, 2008 10:37:18 PM

I finished my Obs & Gynae rotation(of 9 weeks) about 3 weeks ago where we had to perform 15 deliveries by ourselves before you can sit for the end of rotaion final exam...Male students were left with no choice but to get in there and deliver their 15. Maybe the fact that doctors are generally well respected here makes it easier for them. Also the policy is such that we have to sit and monitor the women for 3-6 hours and this kinda helped in creating a bond between you and your mother before going into the delivery room.When the time comes for them to be wheeled into the delivery room,the male student just followed,gloved up and did the delivery.No questions asked.

Posted by: memsdabomb | Apr 30, 2008 11:27:21 PM

hhmmm.after reading ur article i see that some problems are universal!!
in our hospitals these r only male students who can't have pelvic examination or delivery,girls r allowed (& somtimes forced,if they were shy)to examine GU of a male patient.
as a girl i never had such problem

Posted by: z | May 1, 2008 5:56:30 AM

Would an attending think less of a student for respectfully suggesting exam inclusion based on patients' consent? May not guarantee the inclusion, but may increase your chances.

Posted by: doug | May 2, 2008 8:04:19 AM

Thanks for sharing that Anna. I've read a number of your posts before and have found them quite engaging. I hear your concerns. I have just commenced my placements in 3rd year, and recently came up against the same obstacle with a female doctor who performed pap smears & deliveries. Granted these are highly personal areas for women, however there were times when I got the impression it was the doctor who precluded me from opportunity, despite any rapport that I had developed with the patient.

I wish it didnt have to happen to you, however it's nice to know that it's an experience shared by others. Thanks for your post, and best wishes!

Posted by: Phil from Australia | May 2, 2008 8:25:55 PM

hey, I'm in the 7th week of a challenging 12-wk surgery rotation w/2 weeks in ortho and i relate to your experience. the attitude of some older surgeons is that most 3rd yr med students are not good enough for surgery and are only meeting med school requirements. although the thinking might be partly true - because i don't know anyone who's not interested on surgery who would willingly put themselves through 12 weeks of torture, its very insulting to hear as a hardworking med student. however, most of the attendings i've worked with are enthusiastic about teaching students and have destroyed my pre-conceived notions about surgeons. but, there are a couple attendings that i've come accross, and they both happen to be really old, and well-known/high-up in the hospital, who are really arrogant. One of them doesn't say a word to students in the OR, except "suction" or "retract" all the while leaning over the patient so far in that all you see is his back - and he knows it and he does not care! the other one is just very close-minded and doesn't budge in his perception of what a surgeon should be - i.e. Male and Top 1-2% of your class. I'm neither and lucky for me, I don't wanna go into surgery, but it annoys the hell outta me!

Posted by: Fzk | May 6, 2008 7:25:31 PM

I feel your frustration, Anna. I think we all encounter it along the way - in OB, surgery, even medicine! I escaped the big academic centers for my procedurally based clerkships, and am glad because of it. But it still persists. Is your final this week or next? Hang on!

Posted by: Thomas | May 8, 2008 8:48:47 PM

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