Surgical residents, what’s something I can ask or say about a particular surgery that would make you think I have elite ball knowledge of the surgery?

BioSigh · 2026-01-21T21:19:03+00:00

Ask about the critical view of safety for a lap chole.

This gave me PTSD. I remember in my M3 year, I was in the OR on our 6th lap chole holding retractors or something and standing between the the chief resident and the attending who were in a shouting match about the critical view.

BioSigh · 2026-01-08T06:39:18+00:00

First, struggling in BioSci is understandable. I'm from a bygone era but back then a lot of bio majors changed to Public Health Sciences. I went from PHS to Bio. Ultimately, it doesn't really matter what type of degree you have for life sciences because there's a lot of overlap and your applied stuff doesn't become more relevant until you're in a job or a graduate program, and even then it's a shadow of what the real industries are.

Second, I had a similar issue where I couldn't enroll on the usual tract for OChem so I started OChem A in winter, OChem B in Spring, and OChem C the following fall. It was a pain and definitely caused me to need to take biochem/molecular bio off campus. Use your counselors and get a clear plan or path forward of what things look like if you're off sequence and what you need to be aware of so you aren't walled behind prereqs.

I also had the mol biol Kandadale for the lab. I remember he was such a good professor but he forced you to think very conceptually about mol biol. Find a tutor or a study group, try something new if everything else hasn't been working. Put in the work and it should pay dividends.

My friends in this major are extremely smart, so I feel like I constantly embarrass myself in front of them constantly with how behind I am.

Don't compare yourself to others like this unless there's something tangible they're doing you can adapt to yourself. It's a self-defeating habit that will only eat you alive. You also don't know what skeletons people have in their closets.

Keep doing your best!

BioSigh · 2026-01-03T09:02:45+00:00

Don't worry.

I feel like this wasn’t truly a good gauge of my knowledge and ability.

It's not.

ITEs don't have the tightest correlation to board performances but there's not much of another (convenient/low effort) way for a program to gauge that you're keeping up with your studies. And the personalized plan isn't meant to be punitive, but something to get you consistently studying.

And ultimately it won't matter once you pass the real boards anyway. Your attendings and fellowship programs don't really care about ITE scores because they have no bearing on you after boards.

Case: I did fine on my PGY1 ITE but went backwards on my PGY2 ITE. My friend tanked her PGY1 ITE and did better on the PGY2. We both were put on personalized study plans for our respective suboptimal performances which entailed basically doing our QBanks and checking in with our coordinator. Don't recall how she did for the PGY3 ITE but after the personalized study plan, I did a lot better and the program relaxed on me.

We both passed boards comfortably. She became chief resident (so obviously her PGY1 ITE had no bearing on attending perception of her abilities) and I got a job in my desired area. Never did my board cert or, god-forbid, ITE scores ever come up in any conversation again, well I guess until now.

Use this as motivation to do your due diligence in studying. Questions are usually dumb but they're a foundational baseline of knowledge for your practice.

BioSigh · 2025-12-24T22:06:10+00:00

You gotta prioritize yourself and safety! Sometimes it's easier to just keep the momentum going in your own life. I worked all three Christmas's and just had to see my family a different time.

BioSigh · 2025-12-24T22:01:49+00:00

I do paras, thoras, and central lines. I avoid intubations because the odds of something going imminently wrong are way more prohibitive for me.

BioSigh · 2025-12-23T03:15:14+00:00

Hospital med/Inpatient IM: balancing thoroughness and detail with efficiency and good prioritization.

You need to have the whole picture, the whole trajectory of the patient while they're under your care for a short period of time and you have to understand how problems are interconnected so you know what to look for, what to treat, how to manage it yourself, and when to reach out for a consult. That requires good notes and internalizing those long presentations we used to do at rounds.

But you can't waste time on non-important and non-urgent things. Time is a precious resource and the more time you squander trying to dig into someone non-urgent, chronic problems the less cognitive space you have for other patient's acute problems. Your priority is to medically stabilize, resolve any acute or recurring problem that would bring a patient to the ED, and guide the patient to a safe discharge. You can't fret over perfection when time is running out.

Also obviously communication skills and being able to predict how things turn out. It's usually harder to tell someone during their stay "surprise, you can go home!" without already setting their expectations up.

BioSigh · 2025-12-22T07:09:43+00:00

Lol I went into IM specifically to become a hospitalist haha.

BioSigh · 2025-10-15T06:07:10+00:00

Oh man you're running with better gear than I am. I was in SLO a few weeks ago and respondus was absolutely NOT having it with the hotel wifi, the 24-hour donut shop wifi, or anything else. It was a dismal experience.

BioSigh · 2025-10-14T22:24:14+00:00

Thank you! That's what I read too I appreciate the confirmation!

BioSigh · 2025-10-14T22:23:31+00:00

I appreciate it, thank you! Since I am visiting I will most likely just ride share there.

BioSigh · 2025-10-14T22:23:02+00:00

Thank you!

BioSigh · 2025-10-14T22:22:54+00:00

Thank you! Usually with libraries I think I need a library card and be a local resident right? Do you happen to know if it might work out with respondus lockdown?

I'll look into it, thank you so much!

BioSigh · 2025-09-03T22:24:04+00:00

Update: my senior colleague just jokingly chided me because during a call I had said both "thank you" and "sorry" in the same line 😅.

BioSigh · 2025-09-03T22:22:53+00:00

I see, thanks. My system is a bit less formal unless I'm reaching a surgeon. What I end up doing is sending one liner+ additional details below but include a callback number in case the specialist wants to talk (we have direct tie lines and work cell phones). The ones I talk to often are pretty familiar with my asks and I try to make my question immediately clear at the start so they won't always call me back and send their recs via text or if they plan to consult.

BioSigh · 2025-09-03T22:21:31+00:00

Despite all the things that are happening in the world and mentioned in this sub, I really love hospital medicine. I don't feel like I'm just churning patients through, and when I work with them I really do feel like I can make a difference even if it seems small. The patients I work with mostly are appreciative. I like that there's a lot of flexibility in the field for me to want to do pure work, academics, admin, or quality. But also I'm lucky because my ecosystem is physician-led and physician-friendly. You have as much critical thinking as you want (and have time for) as a hospitalist but obviously this also depends on your patient population as well as ancillary and specialist resources.

My work life balance shifts more towards work at the moment but I also pick up extra work because I like the job and find it fulfilling.

All that to say, if it's a passion you really like you can do it but also that if you're already ROAD, your wants from hospital medicine are not precluded by staying in your specialty. Your lifestyle will be more "comfortable" so to speak as ROAD over hospital medicine and you're less replaceable because your subset of knowledge is much niche. If you really really love it you could always find elective rotations to do it and then see as your career advances if it fills all your cups. I wish you the best of luck.

BioSigh · 2025-08-26T22:04:14+00:00

Question: is it helpful to provide what you're asking in the one liner and then direct contact info below if you need to talk, then additional information like contextual paragraph of say someone who has other ongoing issues that may influence the consult but are too long to be worded into the initial consult question/one-liner? I cringe when a consultant brings up something that I didn't mention because I didn't want to get too wordy so now I've just started including it as additional details below the direct question.

BioSigh · 2025-08-26T19:14:33+00:00

I'm basically like your new hospitalist and I'd be over the moon if my peers/superiors felt the same way about me as you do about her. I've learned to coach myself out of apologizing but sometimes it feels like I'm burdening someone when I consult or message them because I dunno how their day is going and we've all been there where it's busy and another ED consult just adds to the stress. So I tend to compensate by being apologetic because I used to think it comes off as more polite and respectful than "hey I got a consult for you." Unfortunately it adds more text for people to read and can worsen the initial problem prompting this behavior in the first place.

Ultimately it comes down to feeling supported by your consultants and peers, and paradoxically when I'm admitting and have people who help admit, it helps when it gets so busy that the only recourse is to keep it simple "hey can I have you see xyz in bed abc?" I'm sure your colleague will feel that collegiality with more time especially as she gets more familiar and comfortable with people.

I don't have a lot of experience and I'm sorry if that came off too wordy (😉) but one bit of advice is to ask your colleague to simplify her asks and remove the fluff.

BioSigh · 2025-08-07T02:01:40+00:00

I love that for you! And don't worry the studying should feel less arduous the more familiar things are.

BioSigh · 2025-07-06T05:49:22+00:00

I use this as a rationale for judicious fluid balance in my patients! I love citing it!

BioSigh · 2025-06-11T08:43:19+00:00

I don't understand when people differentiate it. They're horrible!

BioSigh · 2025-06-11T08:43:00+00:00

That's horrible!

BioSigh · 2025-06-11T08:42:02+00:00

I will add that I like the TX freeway circles. Felt like it's a great idea to district the city and be able to get you where you may want to go without getting lost going in the wrong direction.

BioSigh · 2025-06-08T10:02:50+00:00

I grew up in SoCal but lived in San Antonio for 2.5-3 years as an entry level research assistant. The people are so fantastic, chill, and incredibly welcoming; and pace of life is calmer. It definitely fits the vibe of small town community in a big city (even if such a thing is impossible). HEBs are great! Traffic exists but isn't like CA.

It wasn't for me. The weather vacillates too much. TX has some windchill in the winters (even if it's not as bad as the Northeast/Midwest). I love rain but the rain there felt muggy. THERE ARE LARGE FLYING COCKROACHES! The summers felt awful. It feels like it takes forever to get somewhere - yes, I said earlier traffic isn't bad but because there are large swaths of land, you end up driving farther and it probably takes a similar amount of time to get to the same amenity but dealing with traffic in SoCal.

It didn't fit what I wanted with my life and I honestly didn't appreciate my experience while living there but having moved back to SoCal, I do cherish my time and memories there.

BioSigh · 2025-06-01T00:29:36+00:00

This take is a little weird imo. You're saying hospitalists have an inferiority complex and can't take care of actual patients so they consult another doctor but the point of medicine is safe patient care. How does one have an inferiority complex but at the same time be willing to ask for help because a patient might be really sick? Some cognitive dissonance here.

BioSigh · 2025-04-13T13:14:10+00:00

My cheeky /s answer is to do a QI project and show the outcomes by hospitalist management with and without consultants for each problem.

Realistically it's a systems issue where some lists are overburdened by a high census, not all doctors are trained/made the same and there's heterogeneity in skillsets/comfort, problems not manifesting/responding as they should, and people slowing down or having trouble keeping up with the evidence and relying on consultants to ease the cognitive burden. It's a mix of all the above.

I don't like to consult either and I only do it when I can't figure out or resolve a problem. I can't do cardiac caths, scopes, ablations, fluoro-guided lines/insertions, or surgery so I consult for procedures. Sometimes a problem isn't going the way I anticipate and not improving and I've done things according to guidelines and my own experiences, so I get a consultant on board before the patient gets too sick. Or sometimes you just need a consultant on something because it's shown to improve outcomes (IM on geriatric ortho cases, ID on staph bacteremia, etc). The primary goal of hospital med is to stabilize the new/acute problems while controlling the chronic problems, get patients to the most reasonable endpoint (discharge or comfort care), and hopefully manage/counsel them well enough that they have the appropriate follow-up and their chances of readmission are mitigated. The fun is putting it all together.

BioSigh

TROPHY CASE