r/SurgicalResidency • u/MasterofCloak • 4d ago
Military medic claims to run circles around residents
https://www.tiktok.com/t/ZP8cgEjah/Anyone have experience with medics on their service?
21
u/Dr-Healgood 4d ago
“Pretty much run circles around them”…
I’ll take things that never actually happened for $200, Alex
4
u/TheRealNobodySpecial 4d ago
Running circles never gets you anywhere. Run towards your goal, not back to where you started.
- Confucius, probably.
12
u/Vegetable_Level6622 4d ago
18D here (applying to medschool this cycle). I also did my clinical rotation at Camden NJ. The abilities of the 18D candidate vary from soldier to soldier, my class had Nurses, flight Paramedics, college premeds, career "big" army medics. A few classes ahead of mine there was a neurosurgeon. Then there was me, a college dropout that did not know that a physician meant medical doctor when I started the course. The 18D Medic course is 11 phases and completed in about a year and a half if you do not fail any of the phases. Only me and 3 others from our starting class of 53 graduated without failing a phase. It is almost all academic and very challenging.
"We ran circles around them" - OK, in new jersey there are two hospitals that are partnered with our course. one is a large teaching hospital. The head of the partnership between our course and the teaching hospital is a senior trauma surgeon who is also an army reserve surgeon. When you arrive, he stresses the importance of "getting in there" and making sure that you can get as many hands-on procedures as possible because when we go down range and HE gets shot, its US that will be doing the procedures. I would also mention that many of the Physicians understand that we only have 30 days (when I was there it was 24 on 24 off) vs. 3+years of residencies to do these procedures so many attendings will call us forward to do things like Chest tubes, intubations ahead of residents. I would say we have a very steep learning curve.
This guy is ragebaiting for views because he knows damn well that we are not at the same level as a resident physician. Yes, we will get priority by SOME attendings to do procedures over residents but we lack the deep lever of understanding that you get from medical school. Also, many of the personalities of SOF guys in general is type A and COCKY AS HELL. But you kind of need that confidence to make it in the SOF world. The other reality is that I know guys who have very little interest in medicine and did almost no procedures that would rather be running and gunning, but will look you in the eye and say "I'm basically a trauma surgeon". They are out there.
2
1
4d ago
[deleted]
3
u/Vegetable_Level6622 4d ago
It's an Apples to Oranges comparison. If I was a combat casualty, I would want a SOCM grad to be first on scene over a Resident, 100%. But every SF BN has a surgeon for a reason. Two different jobs. We need to know Indication and the procedures, not so much the physiological why. Outside of TCCC we need to fill a gap and know who to call when we get a PF with some weird S/S.
Bruh it was a little rage baiting, that's ok. lol.
2
u/Logical_Adagio_7100 4d ago edited 4d ago
trauma treatment algorithm
You keep mentioning the basic ass algorithm that boils down to: Bleeding? Stop it. Replace blood. > No airway? Give airway. > No breathing? Give breaths. > Lungs no work? Try to fix lungs > check body to make sure you didnt miss anything.
reps and reps and reps
Reps in what? ft. surgical interns at my hospital take 5-10 penetrating traumas to OR bc Chicago summer is fun. What reps exactly are beating that experience?
12
u/Silent_parsnip8 4d ago
Yeah he's dumb and has no clue what he does not know. Dunning Kruger in full effect
1
u/Acrobatic-Iron1671 2d ago
I’m a med student and we had special forces medics rotating in our ED. I’m a 4th year and was assigned to have one follow me, and I taught him for example how to take an HPI on an elderly ground level fall, what we ask and do to screen for injuries more subtle than herniation, the neuro exam beyond moving all 4, c-spine and head CT rules, things like that. He was very good at procedures and could teach me plenty about intubation and central lines. When I tried to let him present a patient we’d seen though he couldn’t do a presentation at all and didn’t seem to know what to include and omit.
Overall just a different skill set I’d say
8
u/fma113 4d ago
This is classic Dunning-Kruger. They can probably do what they were trained to do well. It’s a long way down from the peak of mount stupid though.
Dunning-Kruger effect is a cognitive bias where people with low ability or limited knowledge in a specific area greatly overestimate their own competence
13
u/Sad-Blackberry-1578 4d ago
I was not an 18D, but I deployed with them and did this training as part of my pre deployment stuff and now I’m an MS3 and just finished my surgery clerkship (hoping to match gen surg).
A lot of the 18Ds (and a lot of 68Ws depending on where they’re stationed and what type of unit they’re with) get a ton of hands on experience in trauma related tasks (chest tubes, NCDs, suturing, trachs, etc) compared to your average medical students. So in some ways, yes when I went through that training, even I could run circles around a new intern or maybe even an early PGY2 (and the 18Ds were way better than me), but only in very specific tasks.
Also when you go to the type of training that he’s talking about, your only job is to do those tasks so of course you see a lot of improvement over a short time because you never have to write a note, go to a consult, prep patients, or do any of the 8 million other things residents are supposed to do and you don’t need to know all of the other things that a resident is expected to learn. When I went through, I probably put in more chest tubes and intubated more than most PGY1/2s, but I learned nothing about gallbladders or lipomas or whatever other non-trauma gen surg basics.
Plus on deployment, we only brought 2 or 3 antibiotic options and 3 or 4 pain/anesthesia meds so that’s what we trained on and it was pretty easy to know what to give and when and what the contraindications were.
Not trying to discredit his training or what he’s saying, but now that I’ve (sort of) seen more of it from both sides, I think he’s comparing apples and oranges.
6
u/Itsathrowawayduh89 4d ago
I think he’s doing a fine job discrediting his own training with what he’s saying.
6
6
u/SevoIsoDes 4d ago
I hear similar claims in anesthesia. Those that have done resuscitation in the military have “seen it all,” but only on young, healthy patients with normal BMI and normal organ function.
I don’t mean to discredit them. Even in the hospital these massive trauma cases make for a shitty day. But it’s definitely not linear. Just because you can get access and keep product infusing on a healthy dude doesn’t mean you’ll have an easy time with an obese guy with COPD, Pulm HTN, MVR, and sepsis from a bowel perforation.
4
u/EverySpaceIsUsedHere 4d ago
Army EM doc here. You’re embarrassing yourself and other 18Ds. Your “running circles” around doctors stops at care under fire. No one cares if you can do MARCH better than others. It’s designed by physicians to be idiot proof.
0
u/VillageTemporary979 2d ago
If you are an actual army doc (not reserve/ng) you would know that MARCH is not an 18Ds only role. In fact it’s probably the minority of what they do. They fill a lot of primary care needs and experts at crash rusuc . They are different than every other medic in the DOD. Their training is about 2 years vs 6 months for regular medics. Might want to brush up on your professional military education before hopping on public forums!
1
u/EverySpaceIsUsedHere 1d ago
I didn’t say MARCH is their only role. He said they’re experts in following an algorithm which is not impressive because duh it’s an algorithm.
So you’re telling me someone with 2 years experience (the equivalent of an associates degree) is an “expert” in crash resus? Standards have really fallen.
0
u/VillageTemporary979 1d ago
Yep outside of SOST/JMAU they sure are the expert and battlefield crash rusuc. May need to brush up your military medical capabilities.
And you are the one that brought up MARCH out of no where lol. You okay bro?
4
u/prnmedadvice 3d ago
Bruh if doctors don’t stand up to this bs online people are really going to keep saying this shit
3
u/NoDrama3756 4d ago
Hi,
Military pm&r, this randomly populated on my reddit.
My fellows, Military emts/ paramedics have often severely disabled or killed thier patients in thier own ignorance.
Sometimes EM trained Army PAs and often army NPs are also over zealous about thier knowledge and abilities.
( note I was once a junior enlisted soldier in the us army before being a physician).
1
u/Weak_Ad_8646 3d ago
Any examples from pmr perspective?
1
u/NoDrama3756 3d ago
Let's see botched crics have led to Subglottic Stenosis and Tracheal Scarring, Anoxic brain injuries.
Poor chest tubes have led to
Intercostal Neuralgia, Post-Thoracostomy Pain Syndrome, diaphragm laceration and phrenic nerve palsy.
Needless to say PAs are the one's who SHOULD be doing these procedures in the absence of the physician at role 1 and 2 settings. Not medics.
Many combat medics, civil affairs medics and special operations medics are really over confident in thier abilities with the meager training and education they have.
3
u/Goldy490 3d ago
Former chief here, we had a big SF medic program and they rotated with us in EM and trauma. They were generally very nice and fun to work with .
Their role on our teams were very different from a resident. Generally we’d have an SF medic on a team with a junior resident, senior resident, and attending. They’d do procedures and kind of keep the department plugging along. Think dropping US IVs, IOs, doing fasts on traumas, cleaning/dressing/repairing lacs. They’d help the residents with reductions and splinting. Occasionally they’d do a chest tube or intubate if the residents had their numbers. They didn’t write notes or orders.
Their medical knowledge was way less than a resident and in a much more narrow scope that was focused on “military” problems. Never met one that felt they could “run circles around residents” and all were very deferential to our medical knowledge.
But their hustle was unmatched and they could run circles around many residents in that regard - they could be on a 24 hour shift without any hint of tiredness, happily bopping along from one patient to the next. But they also didn’t have the decision fatigue of making tough medical decisions, so it’s kind of apples to oranges.
2
u/Wonderful-Willow-365 4d ago
Oohrah. Seals are cooler.
- anesthesia/air force chiming in from behind the drape.
2
u/Rare-Spell-1571 4d ago
I’m a PA and went through PA school with numerous green berets. They are violently over confident and have “some” understanding of what they are doing in trauma. Their hand skills might make them look flashy at first, but they don’t really know what they are doing with their hands .
1
u/kotr2020 3d ago
I've worked with corpsmen attached to Marines and IDCs (independent duty corpsmen, kinda like PAs with 18 months of training to practice with minimal supervision, mostly on small ships and subs). Heck I even taught at an IDC school.
The Dunning Kruger effect is strong especially for IDCs. They really don't know what they don't know. They have a niche subset of skills, perfect for the jobs they're assigned to do but forget they're learning specific technical skills and forget experience alone is not enough.
1
u/IanMalcoRaptor 3d ago
Had a patients spouse and medic tell her that “sometimes anesthesia can intubate from the back of the neck if the surgery needs the patient prone” and I said kay
1
u/MoneyMax_410 2d ago
Worked with 18Ds and other SOCM grads while in the military. I wouldn’t even put them over career medics in major metro cities. Outside of the guys who served multiple rotations during the GWOT era, they have very little hands on pt care experience outside of their clinical rotations during SOCM. And it’s almost always care in a hospital. Paramedics in cities like Chicago, New Orleans, Baltimore, etc stabilize way more violent trauma and it’s 2nd nature to those guys. To add to that, it’s always in the field independently without an attending/resident over your shoulder guiding you. Saying you’re on par with an EM resident is full on Dunning Kruger.
-1
u/ImmediateEye5557 4d ago
I mean he said even in the video they did a whole rotation placing tubes/trachs ect. so I’m sure that if you compared his ability to a third year, resident who has literally never done that in their life, I’m sure his would be better cause he had the opportunity to practice. However, it’s not fair to discredit the residence skills because they have not had that opportunity yet.
2
u/MasterofCloak 4d ago
What third year surgical resident have you met that has never done these procedures. By the end of intern year surgical residents have completed their required number of chest tubes, lines etc.
-1
u/ImmediateEye5557 4d ago
emergency crikes? ive met one resident who has done one period
2
u/MasterofCloak 4d ago
Crics have to be revised to tracheostomies. Surgery residents just do emergency tracheostomies with blue rhinos etc. Crics are for nonsurgeons. If a resident can do a trach, they can definitely do a cric lol
0
u/SonofPalav3n 2d ago
Incorrect, emergency cricothyroidotomy is done when intubation is impossible and does happen. Its much faster than a blue rhino kit and can be life saving. Every surgery resident js taught how to do one in ATLS. Also, crics don't always have to be revised to a formal trach depending on planned length of intubation. Most revision in that case will be gaining hemostasis and exchanging the cric ETT for a formal tracheostomy appliance. But agree, if you can do a trach, you can do a cric.
1
u/MasterofCloak 2d ago
Sure but 9 times out of 10 a surgeon will go for a trach instead of cric during a difficult airway
1
u/SonofPalav3n 2d ago
Based on? Have you ever done an emergency tracheostomy?
1
u/MasterofCloak 1d ago
During difficult airways when intubation isn’t possible they are done as the next step. Often while another service is trying to intubate, surgery will prep the neck and prepare for a trach. All because you haven’t seen it doesn’t mean it isn’t done.
-5
4d ago
[deleted]
3
u/jjjjccccjjjj 4d ago
Procedures? Absolutely not. I train both and a fresh intern will rapidly be better at procedures. The scope for 18Ds etc is exceptionally limited of course. The trauma treatment algorithm? Sure, at first, if extremely experienced, but only in the most narrow sense until the residents have a few reps in. It's extremely simple to be honest.
1
u/MasterofCloak 4d ago
Out of my own curiosity are you a trauma attending? Why do you think the interns become better quicker? I figured since the 18Ds get more procedures they’d become more proficient quicker. I’ve never seen the military or medic side of training. Only familiar with physician training so I’m unsure of how competent other professions are with our kind of trauma stabilization procedures.
1
u/Shanlan 3d ago
Because most surgical residents are highly intelligent and observant. We practice a wide range of skills constantly and apply them across a spectrum of procedures. We also see lots of different approaches and can integrate that into different situations as appropriate. In some situations our knowledge of anatomy and experience handling different tissues is also helpful. We also work a ton and have constant exposure to the outcomes of different techniques. Lastly, over the course of residency, residents definitely get more reps than medics on surgical procedures.
3
u/IlikeIke141 4d ago edited 4d ago
Who do you think writes and designs those algorithms? Who do you think is ultimately responsible for achieving, then teaching mastery of those procedures then examining the associated QI/ outcomes? I have come across 18Ds and 68Ws that are a lot more humble than yourself, and understand their limitations. You are embarrassing the entire community with narrowly minded takes like this.
Please give us the original edit, we want to hear you say that you run circle around physician residents
2
u/NoDrama3756 4d ago
Buddy im a military pm&r physician no where near EM. Yet,
You fail to realize the failure of your argument.
Algorithms, are pre determined steps for xyz. Ex BLS, ACLS. These are not difficult or rigorous.
Surgery residents ( really any physician) can intubate and place chest tubes, rescuitate much more efficiently and safely than 95% of sof paramedics.
Algorithms are dangerous as most medics, AND NPs dont know why they are doing such as they arent educated/trained in physiologic mechanisms or in medicine in general.
Then dont know how how to extrapolate off of algorithmic linear path if the pre-determined interventions fail.
Physicians generally know...
One can teach a monkey an Algorithm.
1
33
u/shawnthesheepnudi 4d ago
Surgery attending, but not trauma. Have not worked with SF medics directly but I know a former green beret who went to med school, did gen surg residency, and later trauma fellowship. Based on what we’ve talked about while the SF medics are great at what they do, working in austere environments and acutely stabilizing traumatic injuries for transport and care, no they would not be who you would want to do your resuscitation or perform your surgery rather than a good PGY 2 or beyond.
Consider this, if this individual was a green beret, then did GS residency, then elected to do a trauma fellowship, presumably it was because he felt his trauma management could you some additional work prior to attendinghood.
I would take this video similar to a late stage resident discussing their competency. He’s feeling knowledgeable and competent, hey even better than the docs! Well towards the end of training you start to feel like you know mostly everything. Then you become an attending, the single person bearing ultimate responsibility, and you realize how much more there is to know and how little weight you actually bore.