Medical role changes feedback

[Pratepresidenten]

Feedback thread for this: https://github.com/Aurorastation/Aurora.3/pull/9303

Medical's roles and responsibilities have been re-reviewed and updated as medical have had a lot of changes made to it, including removal of core and utility features, and tweaks to existing features.

1: The removal of the trauma physician because it was the same as the physician

2: Upping the age of the surgeon from 30 to 35 to signify that they do infact need much more training to operate on other species. So instead of going for needing mandatory extra xenobiology degrees, skills, records etc, this is all included in the 5 year bump.

3: Removal of the Psychologist (Not Psychiatrist) role, possibly move it as an alt-role of chaplain.

[Roostercat]

I am against the five year bump. It doesnt really serve much as an RP purpose, since most surgeons already say the xeno surgery is in their training anyway, and really only serves to force people to make their characters magically older, which is a huge pain in the ass to explain ICly. On top if that it basically makes the requirements for CMO and surgeon the same. Not much if an opinion on the TP removal though.

[NewOriginalSchwann]

I am for the five year increase in age. Surgery is complicated in our current world, and adding multiple species into the mix is only going to make it harder. As for the complaint of "making surgeons and CMOs equal," these are the two (conceptually) most complicated jobs on the station. It's more sensible than not that they'd be a comparative age.

 

I think the trauma physician role is bloat, and absolutely support its removal.

[VVipEdout]

While the five year increase is sensible, it feels like the fast-and-boring way out of the issue of 'how tf do you know xenoanatomy' and doesn't consider how similar species in the Spur are; conversely, 'it's the exact same' is blatantly false mechanics or not. It's not world ending and yet it feels like a waste of writing.

Trauma Physician, though, is not something whose removal I can see justified. 'It's bloat' is purely gamist of a concept, and with the incredible amount of immediately life-threatening traumatic injuries on the Aurora it makes little sense to remove it from an RP perspective. Changes can be motivated for the sake of verisimilitude ideally or for the sake of gameplay loops less so, but both at once and directly contrary to each other in the same PR doesn't just work.

[PTiberiusM]

I am one of the few people that play a Trauma Physician on this station, so I obviously don't like this change.

So we have:

• EMT & Paramedic
• Intern & Resident
• Pharmacist & Chemist
• Psychiatrist & Psychologist

But Trauma Physician was the "bloat" that needed to be taken out? With no Viro, why even have a Chemist role? With all the medical changes, why have two titles for a mental health role that is almost never used on station as traumas are now almost impossible to get? This station needs to bump up the age for its surgeons, but entertains both Intern & Resident programs? This isn't a medical school.

Trauma Physicians make a great deal of sense for the station. They are emergency medical doctors, primarily providing "emergency room" like treatment to patients. Which is what this station should be expecting to provide to its crew members: a doctor specialized in advanced boo-boos.

[MoondancerPony]

I think it waters down the difference between surgeon and CMO, personally. Maybe push CMO up to 40?

Honestly, anatomy is mostly similar across the species--organs are somewhat different, and arranged differently, but having to memorise a couple more mnemonics is not too much more on a surgeon's plate, and hardly worthy of five years extra schooling. Instead I would argue that you'd specifically learn to generalise across (almost) every species, focus more on that, and then spend less time on the individual species, instead just filling in the gaps of what the general teaching missed. Every species except the Vaurca have a closed circulatory system, with lungs or lung-like organs. They still have some form of oxygen-binding protein in their blood, they still have bones, ligaments, tendons, arteries, etc.

The biggest differences are also rather small; organ placement rather than function, combined/reduced functionality, etc. It doesn't take five years to learn about Skrell gill-lungs or the differences between the lobes of the human and Unathi livers; in fact, such deep knowledge would likely be considered the role of a specialty surgeon, while the surgeons on-station would be performing life-saving surgeries or working to the best of their ability despite having incomplete knowledge, and then sending them for proper aftercare off-station. Not every IRL surgeon is a cardiothoracic surgeon, or a hepatic surgeon, or a renal surgeon, or a neurosurgeon, but in 2462 it would be trivial to get at least the cursory knowledge needed for a surgeon to perform lifesaving interventions. Even then, as it stands there aren't major differences for any species other than Vaurca, which are a relatively new species. In fact, a five-year difference would mean nothing, since it's been barely five years or less since Vaurca were discovered.

Instead, we should focus on the biotechnology/sci-fi aspect of our setting. In 2462, we already have neural suppressors, laser scalpels, and the incision management system; why not a surgical HUD to help surgeons adapt better to variant biology? I mean I'd be up for coding a surgical HUD or something in order to explain/facilitate that; some kind of MediHUD alternative with special organ overlays. You'd still need to be a surgeon to be able to do surgery; cutting with a scalpel is hard to do correctly, and is a lot more than just "slashy slashy". You'd still have to be able to perform the same basic steps of making an incision through the skin and fascia, clamping and ligating vessels, exposing the organ, actually doing surgery on the organ (especially in a timely manner, since this whole time you're often cutting off blood flow to the surrounding tissue), then suturing the wound closed correctly (which is a LOT harder than 'stitch it shut').

This way, surgery would become much more about skill and technique rather than about rote memorisation of anatomy. Yes, knowing anatomy on a deep level would help, but it wouldn't be the mainstay of surgical training and would actually be able to make medical schooling much more efficient. No megacorp wants to have to shell out for their surgeons to learn twelve different mnemonics for each species' organs when instead they could just buy a license to use Zeng-Hu SurgiHUDs instead.

OH, and Trauma Physician can just go. The entire Medbay is structured like an emergency department; if you're not a competent trauma/emergency physician why are you even here? Go work on a planetside hospital if you want to sit back and only handle appointments or whatever. Even in real-life this is becoming a reality, with the increase in mass casualty incidents leading to all-hands-on-deck triage scenarios. Trauma Physician's entirely redundant, but honestly I could even see an argument for removing the Medical Doctor title and replacing it with Trauma Physician. Sure, you can roleplay a checkup or something, but it's not your primary job; you're working in an emergency department.

10 minutes ago, VVipEdout said:

with the incredible amount of immediately life-threatening traumatic injuries on the Aurora it makes little sense to remove it from an RP perspective

This adds to my point; Trauma Physicians make the most sense to be on the station, while the general Medical Doctor title makes it sound like you'll be making appointments and sitting in an office waiting for lab results to come back. The only things you'd need to treat that aren't considered trauma are radiation injuries and poisonings (including overdoses), and to be frank radiation injuries would probably be considered trauma in 2462 as an eventuality of working in space.

5 minutes ago, PTiberiusM said:

but entertains both Intern & Resident programs? This isn't a medical school.

This is kind of a non-sequitur. Residents are NOT medical students. Interns and residents are fully-fledged MD-holders who could work in private practice if they so desired, but they're instead choosing to specialise in a certain department or role. I hate how mechanics conflates medical students, medical interns, and medical residents when there is effectively a world of difference between them; yes, some people call residents interns, but that's not exactly correct, and medical students are NOT medical interns. Interns are in their first year of residency, while residents are more advanced, and BOTH have medical doctorates. Medical students are, well, students, in medical school.

8 minutes ago, PTiberiusM said:

Trauma Physicians make a great deal of sense for the station. They are emergency medical doctors, primarily providing "emergency room" like treatment to patients. Which is what this station should be expecting to provide to its crew members: a doctor specialized in advanced boo-boos.

I can't argue against this, however. Frankly, it seems more like the nebulous and nonspecific "Medical Doctor" title is the issue; why would a megacorporation employ what are presumably general practitioners on a station that has had no shortage of trauma injuries in its past, even if you consider only canonical events? Invasions, tanks, hivebots, biohazards, space carp, mining and elevator falls, and so on provide a countless number of reasons for them to primarily employ Trauma Physicians as opposed to GPs/"Medical Doctors".

[CrimsonFig]

i am rather against this change regarding the age bump. this age increase impacts the current playbase with a rather pedantic, contrived, and weak justification for no meaningful benefits, with the benefit directly coming from it's own justification. 'this makes better sense' doesn't quite hold up when you can also easily justify the current state of gameplay with that better teaching styles of the future should reduce the years of training required than what we would anticipate for 2020 irl. further, it doesn't appear to address any unhealthy gameplay or have reason rooted in anything other than 'because it makes sense to some people' without really any supporting connections to currently established lore.
I don't see how artificially expanding the age requirement further will help with immersion from how it is currently or how it can soundly justify the impact it will cause for the playbase affected.

Edited July 7, 2020 by CrimsonFig
clarified that the change im talking about is of the age increase

[Carver]

I agree with both proposed changes. TP doesn't inherently add anything not already covered by other roles, and doesn't present enough flavour to cover for it. Ideally we shouldn't be having surgeons grazing 30 anyways, and the hopefully very few that do will only need to make a small and harmless numbers shift in their records.

[Peppermint]

I'm not a huge fan of the TP removal. It doesn't impact me personally, but seems a shame for characters who've used it.  I think a better 'fix' is to allow them to do shit like arterial/lung repair/ect when there's no surgeon. It always seemed a little silly to me they couldn't. For the same reasons of 'bloat', we could also get rid of atmostech given engineers tend to do the job anyway, cook/chef - we don't need  both - chemist/biochemist, ect. I dunno; I feel they add flavour, so having the option is nice.

 

For the age thing, it feels a little pointless? Like, ,aside from vaurca, everything mechanically works the same way anyway, so assuming it's in their training seems sensible. Again, doesn't personally affect me, but I feel bad for characters that suddenly need to mysteriously age in a way that doesn't really add anything. I can understand the reasons behind it though. 

 

 

[MattAtlas]

I've had to bwoink many, many trauma physicians doing surgery because the role itself is an enigma. All of them thought that due to the name they can do surgery, and they can't. It's a physician that does physician things with a different name. There's no alternate roleplay to be had here, because there's absolutely zero mechanical differences.

I basically made this role, and imo, it has to go.

[UnknownMurder]

9 hours ago, MattAtlas said:

I've had to bwoink many, many trauma physicians doing surgery because the role itself is an enigma. All of them thought that due to the name they can do surgery, and they can't.

I was just going through the forums. This statement caught my attention and I had no idea it was prohibited. The wiki dictates and allows Trauma Physicians to be able to do surgery. This change was recognized, carried over, built on, and reinforced  by @geeves and @Cnaym that Trauma Physicians can in fact do surgery. 

@MattAtlas, this brings me to ask you this million dollar question. Do trauma physicians know surgery or not at all?

 https://wiki.aurorastation.org/index.php?title=Trauma_Physician

Edited July 7, 2020 by UnknownMurder
mattatlas

[VisVirific]

Originally, I was very confused and a bit worried about the PR since it gave no indication of what type of thought went into it, or even if there was a discussion behind it. The clarification I got in Discord sounds reasonable (despite the momentary concern about Surgeons needing yet another degree, but even that was clarified as just longer period of training), although I do have some concerns about what might happen to the characters who would have to adapt them.

As for actual opinions, mine are as follows:

 

• Trauma Physician Removal

I'd prefer not to, and I'd suggest expanding in a more concrete way of the exact type of surgeries they're allowed to do in their own wiki page, because as is it merely says "[...] however you are specially trained to be able to do basic and advanced surgery if there are no surgeons available." and "As a Trauma Physician, you are much more skilled in emergency surgery than a standard Physician. As such, you can comfortably manage basic and even advanced surgery procedures on your own." those feel somewhat vague descriptions of what they're actually able to do, since I've heard that they can't do Arterial Bleeding even though it falls under Advanced Surgery and it's a specifically critical surgery to know.

Asides that suggestion, I only have the aforementioned concern in mind. Changing them from Trauma Physicians to either Nurse or general Physicians could be considered a bit much and just pretty sudden without something to help the transition.

• Surgeon Age Increase

I'm still on the fence about this one. There's a lot that I agree with Moondancer's point of learning a generalization between all of the races (with the exception of Vaurca since it's been barely five years) and a reinforcement to express the differences through the technology, as that feels a better alternative to this problem if it'd require more effort to apply.

On the other hand, I really wouldn't mind if the anatomy differences were expressed more to help justify the longer period of learning, be those expressions mechanical or lore or pure flavor. Even a small difference of text when you begin an incision on an Unathi's skin to be more forceful in contrast to a Human's would be really appreciated.

But as is, I'm still undecided. I'll need to give this more thought.

[kermit]

Okay, normally I stay off the forums for the most part, but I’ve seen a handful of lamentable changes to Medical recently and I tend to regret not commenting on the feedback posts regarding them.

Keeping it brief and tackling only the suggestion to remove the Trauma Physician role, I was honestly expecting it as the role was utterly gelded by the somewhat recent stasis bag nerf. Since the introduction of Brainmed, trauma physicians have generally been recognised by people in medical as the folk who are incredibly capable of orchestrating the treatment of patients who are asystole or incredibly likely to go into asystole, knowing exactly what to do and how to instruct 2 or 3 other people to help them. Quite often, you would see a patient in the middle of the ICU in a stasis bag with a trauma physician and a couple of other medical staff looking at a scan planning, in depth, how they would tackle each problem causing the patient’s asystole, with the trauma physician usually being the one taking point. I’m not aware of how many people have been in situations like this but these moments are arguably some of the best moments I’ve had in the year I’ve played in Medical - people all gathering around a stasis-bagged patient, scan in hand, taking around five minutes to just devise a treatment plan for saving someone - and I’ve heard similar from other medical players.

 Lately, these situations have become an incredibly scarce sight as, with stasis bags being nerfed to the point where they are now more reliable at putting someone into asystole than aiding in taking someone out and to the point where people are incredibly hesitant about using stasis bags that they may as well have been entirely removed. It is now impossible to spend ~5 minutes assembling a group as a trauma physician where you can then plan with others how to save a patient’s life, which was arguably one of the biggest features of playing trauma physician that I noticed when playing trauma physician myself and when admiring how other people played trauma physicians. 

To argue that, currently, trauma physicians are not bloat would be a tad silly because, right now, they are bloat, though not because they’re a role identical to the physician role or because they add nothing to Medical, because they do, but instead they’re bloat because everything that made trauma physicians attractive to play has been gutted - the nerfing of stasis bags prevents them from gathering a group of medical staff to plan and orchestrate the resuscitation of a patient who is asystole because, now, by the time you get a group of people to help you in the ICU, the patient is already dead (if not stasis-bagged) or with blood oxygenation levels that won’t rise depending on how long you bagged them. What used to be a role where you could communicate with those around you closely to devise a stratagem to treat asystole has been reduced to a role in which you’re under constant pressure to act fast, without communicating, because you have no means of delaying the progression of the asystole case via the use of stasis bags which would then allow you to communicate and plan. Not only that, but the crack down on trauma physicians doing surgeries, despite them being, arguably, more qualified to perform some of the more advanced surgeries than regular physicians, who are akin to internists in my view, has also removed the attraction to the role. I don’t see myself playing a trauma physician with the recent changes, and the trauma physicians who I have seen play the role lately are playing it more for backstory purposes than the actual role differences that there used to be. The role of trauma physician has been made to be the same as the physician role, when before they were quite different, and that's where the problem lays, from my perspective of things.

So, with all of that said, and I hope I didn’t delve too far into the stasis bag issue which isn’t part of this pull request, though I felt it necessary to give some context, I’m against removing trauma physicians because, while they are not so dissimilar from physicians currently, I’m hoping that there will be a better future for the role - especially when the Next Big Thing comes around - where the differences between the roles are more visible and can be appreciated again by people who enjoyed playing the trauma physician role, though this may just be wishful thinking on my end. Removing the role has no benefits.

I’d also just like to encourage any other people who have or do play trauma physicians to chime in on what they believe made the role attractive to them and whether the sentiment I’m expressing is one that others may share, whether recent changes made the role as similar as it is to physician nowadays, or whether it has always been similar. I'll be fun hearing the opinions of other folk who play in Medical.

Anyway, thanks for reading this. I said I’d keep it brief but clearly I haven’t.

[wowzewow]

I don't really like the age increase.

It feels like a contrived blanket solution.

Anyway, isn't this the 25th century?

I argue that the improvements in technology and education effectively counteracts the increased educational load.

Again, to reiterate Moondancer's point, only a general knowledge is needed. Aurora isn't about specialist treatment.

 

Sure, I can buy the difference in species' anatomy leading to the increase in training time.

But for this to make sense, wouldn't literally every other medical job get an age increase as well?

For the chemists, they'd need to keep track of the different bodily chemistries and overdose thresholds,

Paramedics, expected to do simple surgeries also need to keep in mind the anatomies as well.

 

I'd rather suggest if age depended on the educational background,

The well funded Eridanian Medical College would teach surgery much faster than the State-run Adhominian Military Hospital.

 

[MattAtlas]

On 08/07/2020 at 20:45, SadKermit said:

...

Very good post. I'll take a look into alternative changes for stasis bags instead of what we have now. I wasn't really ever told they were this important and from my experience, they weren't.

Edited July 9, 2020 by MattAtlas

[furrycactus]

As somebody who primarily mained the Trauma Physician role before IRL stuff started bogging me, I'm pretty sad to see that it's gotten the axe while I've been gone. I'd chime in with my own input, but SadKermit has articulated it perfectly. The role had distinction and a clear thing to it; you were the primary handler of patients in critical condition, you took the patients in shock or asystole, you oversaw the ICU and made sure triage was being adhered to. You made sure patients became stable before you handed them to surgeons or nurses for the non-life threatening things like fractures or painkillers and discharge - and notably, like Kermit said, you stasis bagged those that were particularly fucked, you made sure anyone else was tended to, and then you got the whole team together, communicated, and formed an in-depth plan for how everyone can synergise to treat the bag boy. Some of my absolute favourite scenarios in Medical happened in situations like this, where you worked with the whole team to hammer out a plan of action, and nothing beat the adrenaline when the bag was opened and everyone went into sync. When you got a team of three to five people all working together in an OR to keep the patient alive, even if they died, those scenarios were some of the best - and the roleplay that followed after, regardless of the outcome, was always fantastic.

Like Kermit said, the change to stasis bags effectively removed arguably the best part of the Trauma Physician role, which left them not all that different from regular Physicians, despite the general expectation that you're still supposed to be the one handling the critical cases (which I think should still be enough argument to keep them around regardless). I'd personally think the role should make a comeback, along with un-reworking the stasis bags, or at least tweaking them to be more viable to use again.

As for the age for surgeons, well, it seems fine to me, but I do empathise with the people who have to age up their characters to keep playing the role.

[Pratepresidenten]

OP updated to get feedback on the relocation of the Psychologist.

[Roostercat]

I am still against the age bump of surgeons, but I am also against removing psychologist. Mostly due to the fact that there doesn’t seem to be an actual reason to other than ‘we felt like it’. Bloat is also not a valid reason to remove it. All removing it actually does is chip away MORE variety from medical and make it even more stale than it has already become. It makes even less sense to shove it into a chaplain alt role as psychologists do not tend to operate out of a church as far as I know.

Edited July 15, 2020 by Roostercat

[greenjoe]

if psychologist was to be removed from the medical team, it should be made into it's own thing, alongside councilor, who would operate out of their own office, separate to the med bay or church, since councilor is kinda a non-religious thing too

though after a bit more discussion on the discord, removing psychologist as an alt title would be odd, as they're a doctor. if anything the chaplain alttitle councilor would make sense to be a psych alt title, seeing as the three all relate to mental health?

Edited July 15, 2020 by greenjoe

[N8-Toe]

Psych being part of medical is good as it allows communication between them and the rest of medical, as well as lets them be part of a department of people to hang out with when nothing is happening. 

[Snakebittenn]

Why is the Psychologist thing not a separate thread?

[MoondancerPony]

Editing the thread after you've gotten a lot of feedback, without responding to it, to introduce yet another highly contentious change is a weird and offputting thing to do; doing so without addressing any of the criticisms or questions levied against the two already-present changes, or even an engagement with the thread beyond "edited to add another change to the OP" is even worse. I agree that Medical needs to change somehow, but I don't think this is the way to go about it.

[Pratepresidenten]

1 hour ago, Snakebittenn said:

Why is the Psychologist thing not a separate thread?

Because it will or wont be a thing alongside the two other points as an overall adjustment to medical.

1 hour ago, MoondancerPony said:

Editing the thread after you've gotten a lot of feedback, without responding to it, to introduce yet another highly contentious change is a weird and offputting thing to do; doing so without addressing any of the criticisms or questions levied against the two already-present changes, or even an engagement with the thread beyond "edited to add another change to the OP" is even worse. I agree that Medical needs to change somehow, but I don't think this is the way to go about it.

This is a feedback thread for an ongoing project, much like a questionnaire, this isnt meant to be a back and fourth discussion.
The point of the thread is to gather all your opinions and views on the proposed changes and take all these into account and work with them for the betterment of medical. If all the proposed changes are scrapped, so be it.  The rest of the cleanse is going ahead as planned with removing virology/cloning and updating do's and dont's for the various roles to give old and new players a quick and easy overview what their role can and cannot do.

Nothing in this thread is set in stone, so I dont understand why you are pushing back so hard.

 

So far, with the feedback:
1) There is about a 50/50 split on age-bumping, with more arguments against than for, so this might get scrapped.
2) There is also about a 50/50 split for removing the trauma physician, with a lot more argument against than for, where we will be actively looking at completely fleshing out this role to make it distinctive instead of a carbon-copy of the physician, but with a fancy title.
3) The relocation of the psychologist from medical is mostly negative, but some thought will be given to a joint role with a separate workplace for a coucellor/psychologist role, which will be given its own thread as it is the merging and relocation of two different areas if this is to even happen at all.

 

I hope this clarification eases your worries that we're not just gonna strongarm changes regardless of community feedback.

[WickedCybs]

I am overall neutral on what happens to Trauma Physician. The Medical department does not really function like a hospital. In the end, the "Medical Doctors" essentially act the role anyway, with or without a dedicated Trauma Physician on the manifest.

For the age increase. Not a fan, but whichever way it goes I won't mind it. As said before, species on the spur are rather similar. There would certainly be differences to note, but It's hard to see five extra years. Thirty five is also practically middle aged for Unathi and Tajara. For a surgeon? Perhaps fitting despite their short lifespans, though it is something to note.

Third. I think psychologists still have some value to medical, and it is good for the department to be kept up to speed on things from them depending on the situations. If they are moved outside the department they might face issues regarding interaction since service is already very scattered. I also do not think it is fitting that they would operate out of a chapel.

[KesterShadowHair]

Hello.. someone who actively plays TP alot on the server during the deadzone hours. I've found the role niche and fun to play personally. I would argue it needs set structure just as any other role.  I've been bwoinked for things I've had other people tell me I can do. I look at a TP as an ER Doctor comparatively. The entire medbay to me on aurora is set as a emergency basis as most people don't need appointments and or don't utilize the feature realistically.
The wiki states:  As a Trauma Physician, you are much more skilled in emergency surgery than a standard Physician. As such, you can comfortably manage basic and even advanced surgery procedures on your own.

These can be performed by Surgeons and some Physicians. Organs in the chest and lower body| Arterial Bleeding |Autopsy| Hardsuit Removal. <--- I've been bwoinked for these. 
Overall don't view any of this as salt I'm looking at this thread as a suggestion/feedback.