What are the tips, advice, or rules to complete a residency in surgical branch toxic dept and untrustworthy colleagues?

Jousting is the norm in most surgical units, until proven otherwise.

Unlike medical branches where hands on is no big an issue, a career in surgery is hard to progress without decent support from seniors and faculty.

Of course, as is human nature of “Power corrupting people”, you are at times at the mercy of incompetent nincompoops whom you end up working for.

There is no denying this. In fact, RCSEd, has went far ahead as making a campaign on stamping out bullying in surgery.

In most institutes in India, although this is rampant, nobody wants to complain, nobody wants to hear this and nothing is likely to be done.

The higher the name/fame of the institute, more toxic the place, roughly this is the norm, variations are always present. Frankly, this has been a major detractor for me to consider against choosing central institutes.

Below are a few tips from my experience in surgery and its specialities thus far, you may choose to disagree with one or all of below and that’s totally fine. I don’t expect everyone to share my same thoughts or perspectives.

Navigating the surgical residency maze:

1. Choose a simpler / friendly department to work with instead of horror shows. You can get an insider view to any surgical unit by spending some time with a few contemporaries who are working in that place. Know the lay of the land before jumping into it.
2. Know thyself. For example, I am a kind of guy who works best when there is no undue micromanagement from superiors with good deal of independence at patient management with senior help on ad hoc basis. Most places can be tyrannical about how and what you do.
3. Colleagues, at least most of them are not your buddies. Workplace is different from home, school or neighbourhood and the higher you go, chances of finding friends decrease. So be careful whom you confide in.
4. Not all faculty have your best interest in mind. If they feel you are threat to their survival or find you have a better hand / good at decisions, they can go out of their way to eliminate your growth. Be stupid, sound stupid if that helps.
5. Not everyone whom you assist a case with will let you operate, pick carefully who you scrub with, otherwise you will end up with retractor/suction till you graduate.
6. Speak less and only when required. No senior likes a junior who is smarter / better than him. Better keep it shut than be an unnecessary target.
7. Don’t reveal all your plans of future and put the baggage out on the table for display to everyone. Be observant and plan your future accordingly.
8. At times, you may end up working for seniors who have less competence / limited experience, be patient and avoid contact unless required. These are the ones who don’t know how to get things done and blame juniors for every issue. If you need to encounter them, keep it brief, to the point and say yes. They usually back down. Useless to argue with such.
9. Don’t really rely too heavily on what is taught or done in your unit by faculty and academic sessions of the department. Always have your own little plan to learn properly at the back of your mind. Elsewhere I have mentioned useful resources for surgical training.
10. Work will always be there and everyone will rush you to get it done and frankly no one really cares if you are dead, they just want the damn thing to get it over with. In such cases take care of your sleep and diet as sacrificing them will only add to TB flare ups seen in surgical residents of PGI and the likes.
11. Be really nice to support staff who are good to you, porters, nurses, theatre staff etc. More often than not they can be of immense help to you during times of need. I remember many such people who made it a point to go out of their way to help me and I reciprocated their help in some useful way.
12. Some can be control freaks, no matter how wrong their damn decisions are, they just want to get it done, in such cases unless it is against patient interest, better to finish their designated task rather than foul your day with their wrath.
13. Of course, everyone needn’t be this bad or good and frankly nothing is in black and white but exists in shades of grey depending on situation and mood of person.
14. Avoid times when faculty can be hungry and make horrible decisions, just before lunch etc. They can get real cranky and spoil your day. For example, this would be a bad time to ask for a leave or update on your thesis. Be conscious of these factors although trivial.
15. No one gives a damn if you learn your surgical skills, all they care about is themselves and frankly why would they? Don’t expect any senior or faculty to come up and offer his chances of operating willingly to you. It falls upon you and you alone to plead / pursue / nudge them to let you learn/ operate.
16. On average, the higher the number of people working in your unit, your chances of operating go down. I have heard stories where final year PGs do what I did in year 1 of MS. An army of SR’s, adjunct profs, asst profs with you way down the hierarchy is not something I would be comfortable with. Lean, mean organisation even it it comes with extra work is fine.
17. Try to be ahead of the curve by reading up related issues for a particular ward case of trying to go over the surgical steps for a surgery. If you have some idea, your chances of learning something useful go up.
18. Try to be nice to your juniors and do not grab their chances to operate, more often than not they watch your back and can turn into useful allies.
19. Over time, we did on average higher number of surgeries and held better relationships with our juniors and managed more busier clinics, emergencies and theatres than most of my seniors. I felt they were no better at work but for unnecessary arguments with near zero knowledge on how to get things done.
20. Further not everyone who joins surgery has an aptitude for it nor do they share your enthusiasm for it. These are the real sludge and can decimate your fervour. Most of whom I came across were into surgery for a simple reason that they couldn’t get medicine or radiology. You can quite rightly expect the pathetic work culture they bring in.
21. If even after 2–3 months into a department, you feel that its unbearably toxic as each one’s threshold and perspective can be different, considering switching branches or place of work. People were pushed to committing suicides, TB infections and breakdown of morale by working at such places. Pick wisely.

Surgical training is one big maze, you can get slaughtered if you don’t play your cards right.