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General Surgery Rotation

Sup ya’ll!

Not going to lie… I was dreading this rotation. Mostly from horror stories of rude surgeons, super long hours, the constant pimping, and never having any down time or time to read. In all honestly, I had a pretty great experience.


Was it grueling? Yes.
Were there long hours? Some days, but not all.
Did I know what I was doing? For most of it no.
Did I learn a lot? You bet!

My preceptor had a busy schedule, but it could have been worse. He also stressed to me that I was a medical student, not a resident. So my job was to learn and be exposed to things, and I could build upon it later. I was in clinic and saw in-patients/did consults, but spent most of my time in the OR.


I was honest with him upfront: I was nervous because of the horror stories of former students on surgery and that I was currently interested in peds. But that I was going to give it my all and learn as much as I could. He was happy with that response and taught me what he felt was appropriate.

He did give me a word of advice though: not all preceptors will be okay with that honest opinion. In fact, he said some surgeons (usually the old school ones) will find it a waste of time to teach you if you say you aren’t interested in surgery or you aren’t sure. You’ll have to gauge your interactions. I prefer to be honest and upfront and to deal with it later if need be. Use your approach how you see best fit.

Luckily, he let me scrub in to every single case. That’s right! He let me scrub in all the time. Some surgeries I was only assisting with suction, others I got to retract. After 4 days his PA-C started letting me take on first assist with him, and would guide me when needed or jump in if things got hairy. It was with her, (his PA-C) that I got to learn how to suture and close. She helped teach me how to hold tools. And if it weren’t for both of them, I would still have no idea what I was doing.


What was my schedule?


So, most days I would meet my doctor at 7am. Every. damn. morning. I live 40 minutes away from the site, so most days I was up early!

I spent 4 out of the 5 days my first week in the OR. The other day was a clinic only day. During the second week, I had 2 days in clinic, but all 5 days had cases. So for some days I would be back and forth with my physician seeing patients in clinic and then doing a case in the OR.

5:30am: The latest I could be up out of bed.
6:00 am: Needed to leave! Most days I could do everything within a half hour of waking up.
6:45ish am: Arrive to hospital campus. I needed enough time to park, get to the OR we were in (my preceptor worked out of two separate buildings on the hospital campus), change into hospital scrubs, drop my stuff off, find what OR we would be in, grab my gloves and gown (and let the surgery techs know I would be with him on every case that day), and try to scrub in. I preferred to scrub in my first time without an audience… The first several times I completely bathed myself in attempt to stay sterile and would have to go change my scrubs. Plus, whenever the doc was ready to scrub in he wasn’t waiting on me.
7-7:10ish am: Meet my preceptor. We would go greet and prep any patients that were there first thing. Occasionally if we had time he would pimp me, particularly if he had me read a specific topic.
7:30am: Usually our first case would be roomed by this time. Since I already scrubbed in, I would use the Avaguard gel and scrub in that way. It was quicker, although much much goopier! Then I would get gowned and gloved, and wait for things to begin! Sometimes I helped set up the rest of the sterile field. But because I was the newest member in the OR, most of the team didn’t want me touching anything. I get it, I’m the most unpredictable in the OR as I’m new.
7:30am-end. Sometimes we would be done at 2 pm, sometimes we would be done at 7:30pm. It all depended on how the cases went and how quickly the OR turnaround was.

Once I was done for the day, I would usually go home, eat, shower, and read/do Anki cards. If I was too tired, I wouldn’t study and just go straight to bed. Somedays instead of studying I’d practice suturing and holding my tools.

Clinic days were very similar. I would usually start around 7am and look up my first couple of patients for the day. He had me see new patients, and he would usually see the post-ops and do procedures without me. There were times where he had me come in for teaching purposes or because there wasn’t another patient to be seen.
After looking them up and looking at imaging reports and the patient was roomed, I would start the visit. I did the history and physical. If my preceptor was ready, I would present what we talked about and we would go see the patient together. That way I could hear what additional questions he asked and the plan of care. Unfortunately, I only had the time to present it took to walk from his computer to the room. And that was a very short walk….


If he wasn’t ready, I would start writing the note. I usually left my plan open as he was specific about it. Since we hadn’t been in the room yet, I didn’t want to guess at what he wanted.
My clinic days usually ended around 5 or 5:30pm. Then I would go home and study or practice suturing.


How much pimping happened?


I would say a fair amount. There were days where I felt prepared and other days where I didn’t. Anatomy is a big thing to know. But there is a lot more that you can get pimped on. And depending on the preceptor will depend on the types of questions you’ll get asked.


If he specifically asked me what I read the night before (sometimes I would just read and he would pimp me from there) or if he specifically asked me to read on a topic the day before he would ask me questions pertaining to that. Other times while in the OR he would just randomly ask me questions.


Did I struggle? Oh hell yes. All the time. BUT, he was very patient with me.
Does pimping scare me? No. This is an opportunity to learn.

Yes, there will be preceptors who belittle you for not knowing it. But you are medical student. This is your first time seeing patients or even being exposed to that branch of medicine. If you are embarrassed about not getting it right, you need to go home and learn that topic. And honestly if you get super embarrassed, you’ll probably remember that fact forever. That is why you get pimped. It is a way to ingrain information into you.

Since there was a lot of laparoscopic surgeries that my preceptor performed, trying to orient yourself in the body is hard. Specifically because your first two years you are either working on cadavers that you open entirely up OR you are looking at a drawing in a textbook. But seeing things laparoscopically does help with orientation.

Oh, and how much anatomy you forgot too. Yea. I didn’t expect to forget that much.

Sterile Fields

This is a big thing in surgery. A chunk of the surgical techs and nurses working with me were patient. They came off strong at first, but as long as they were willing to show me the correct way I wasn’t upset by it. I get it. It’s their job.

Some co-workers had a stick shoved up their bum the whole time. They took personal offense that I was a student in the OR and felt the need to be breathing down my neck at all times. Whatever. At the end of the day, as long as you are following protocol, staying sterile (and following proper techniques!), you answer to the physician.

Lesson in sterile fields, because let me tell you I was super shit at this. I had practiced scrubbing at least in OB/gyn, but did not remember how to gown very well. I needed the surgery rotation and to do it multiple times a day for ti to really sink in.

  1. You need to do a full scrub when you first get there. You are welcome to do it before your first case and not use the gel, but I preferred to do it once in before hand. As I mentioned earlier, I had trouble not getting water all over me. And also, my preceptor wasn’t going to wait for me. You should be taught how to do this, but I did record a video on my instagram of how to do this as well. You need to scrub for a full 5 minutes. Fingers up, elbows down. Don’t touch anything once you’ve started scrubbing. The hardest part is going to be getting used to being aware of where your hands and body parts are at all times in space.
  2. Drying off is also a special procedure. If you walk into the OR after your first scrub, there is a special way to towel off. If you’ve never done it before, ask the scrub techs to walk you through it.
  3. Keep your arms/elbows away from your body. When drying off, you need to basically stick your booty out and your arms extended a bit in front of you so you don’t touch anything with the towel other than your hands. Again, you gotta practice it.
  4. Gowning and gloving is also going to need to be practiced. I had people to help me with each case. Once they were comfortable with me getting help from them, they taught me some ways to learn how to glove myself. But overall, you should learn this at orientation or in medical school, and you’ll just have to keep practicing it.
  5. No arms above your head! I learned that the hard way.
  6. Learning to be aware of the space. Anything blue = no touchy. Don’t go near it. You can go near it once you are gowned, but even then you really shouldn’t touch it.
  7. The only sterile part of you is between your mid-chest to your waist. Keep your hands in this area or your hands firmly on the OR table at all times. Your back? Not sterile. Under your arms? not sterile. Your lap? You guessed it, not sterile.
  8. I recommend watching the surgery team fully set up a patient a couple of times so you can see how it is done.
  9. There is also a specific way you need to apply the sterile gel. You can only use the gel after you’ve actually scrubbed with soap and water. You cannot just use the gel by itself. You are always welcome to manually scrub before each case, but the gel is faster. But very goopy.

What you see

General surgery is vast. It depends on your preceptors specific niche of what they do and where they are practicing. I saw a ton of gallbladder removals and hernia repairs. I also saw an adrenalectomy, Nissen fundiplication, lipoma removals, and a lot of breast surgeries. Other general surgeons will do vascular procedures. My particular preceptor no longer did anything with small bowel or colon, since he had two colorectal surgeons as partners. You may see a lot of this!

I also saw a ton of PD catheters. Apparently, the area I had my rotation in is the largest area where people receive peritoneal dialysis. My preceptor mainly places them, so I saw a lot.

I’m sad I never saw an appendectomy, but you’ll see a lot of those too.

Again, it all depends on your preceptors niche of what they do and where they are at.

Studying:

Oye Vey. I felt like I was trying to put as much into my brain when I left clinic and the OR as I was while there. Study tools vary greatly, but a few that are always good to have:

  • Pestana’s surgery notes. It is a small book with quick high yield highlights. It is a great preview of topics, but doesn’t go super in-depth.
  • Surgery Recall. Great book. Has lots of great questions that you may get pimped on.
  • Anki. I mean, I tried to used part of the Dorian Deck for studying for this. But most of my studying came from looking up surgical recall and reading from the textbook my preceptor recommended.
  • optional! Recommended book by my preceptor: “Essentials of General Surgery and Surgical Specialties” by Peter F. Lawrence. Each preceptor may have a specific textbook they like. This one was recommended to me to have. I did read a lot out of it, but you may not have to buy a specific textbook for your rotation.

Everything else was mainly me reading/looking up topics I was assigned or picked and learning how to suture as I mentioned earlier.

Tidbit: My preceptor recommended I keep a notebook of all the things I learn in third year so I can review it from time-to-time. He also recommended I only pick one thing to learn about at home a day. And to REALLY learn it. So I typically tried to do that, but mostly I was learning about an entire subsection of the body. So for example, I would read about the gallbladder and everything to do with it.

Unfortunately, I have several notebooks/mini notebooks for each rotation and I haven’t had time to transfer it to any one notebook…

Conclusions

Honestly, I didn’t expect to enjoy it this much. So much so that at this point in time, I am torn between continuing peds or doing general surgery. I enjoy being around kids because they are super fun. But on the flip side, I do enjoy using my hands and being able to tick off a box after a surgery/procedure.

So because of that, I will want to do another rotation in general surgery which I will do this spring. But honestly, I think I’m going to go for it. And if things don’t work out I can always fall back on peds!

Get ready to be exhausted on this rotation. Get ready to get your butt kicked. Get ready to not know much and learn a lot; both about surgery and the body. Surgical fields, scrubbing, suturing, holding tools, where to stand is all part of it. On top of that, you are going to see body structures in a new plane under laparoscopic. You are going to have to try to orient yourself if things aren’t in place like your textbook (and normally they aren’t). And you are going to have to re-learn all the GI stuff since that is a lot of general surgery lol. But it can be fun as well. Make the most of it just like you should make the most of every rotation. Third year is about exposure to different specialties and exposure to learn as much as possible. Soak up what you can as you may not get to do it ever again.

Until next time…

What App’s I use

Hello Medhatters!

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I figured I’d give a break from my normal types of posts today. Instead I’ll list/discuss the apps that I like to use that I have on my different electronics that I’ve found helpful in medical school. Enjoy!

Just a quick disclaimer:

None of these are affiliate links or me promoting them for monetary gain. The reality is 1) I have no clue how to do that and it takes too much brain power and time to figure that out and 2) I'm too small of a blog for anyone to care for that.
So really this is just a for your information on what I've found helps me!
Phone Apps:

– Mail app. This comes on my iPhone and I’ve added BOTH my school email and my gmail on it. My school sends out several emails a day; some of them not very important, some that I can wait till later to deal with, and some that are very much a RIGHT NOW kind of vibe that need to be answered or looked at. It helps to have this active on both my phone and iPad so I can see any important emails right away.

–Calendar. This one also comes on my iPhone. The school’s calendar is constantly updated (as long as you put in the right calendar for your class). Since things can change last minute, and really I’m always looking at this to see when I need to be on campus or what lectures I need to make a list of; it is important to have it in a spot you will be able to get at easily.

–Forest. I believe I’ve mentioned this one before, but both Forest or Flora do the same thing. The Forest app locks your phone for a designated amount of time. During that time it will grow a tree. The longer the timer you set, the bigger/more intricate looking-ish the tree! Flora does something similar but with a flower. Plus, after so many trees that you “make” via not using your phone, the app will plant a tree. (Limit of 3 real trees planted per person though; they have lives too people).

–Minimalist List. I recently started using this. But I needed a list that I could easily cross off or add/modify on my phone. I found that the notes sections/task app that comes with my iPhone just isn’t cutting it. Let’s be honest: I keep hitting ignore on those reminders. It also cuts down the amount of random papers I have of making to-do lists for my study tasks. Plus, I like how sleek and minimal the app is!

–Headspace. I’ve most definitely tried this app and I know a lot of students on campus use this. If anything, they use the quick 3-10 minute courses. They also have sleep sounds: great to help you relax enough to fall asleep when stressed. Apparently at the beginning of the year when I wasn’t paying attention KCU was able to get you at least the sleepcasts they have for free. Otherwise, you do need to pay for access for this.

–Reef Iclicker. I need this for class. This is how they take attendance in labs and for some lectures, and how we answer in class polls. I have it on my iPad but my phone fits in my pocket easier and is always on me. If you were in the COB this is the same exact program you used for in class questions/quizzes.

–Groupme. My class uses this one to talk to each other. And without the school being able to access the account. Its more or less a giant group text of all the people in my class with the ability to have an open outlet if frustrated, want to give friendly reminders, etc.

–Pandora. This is on all of my electronics. I turn on the Lindsey Stirling playlist and study to this. Its mostly instrumental (on my set one anyways) but not just piano, which means I won’t be tempted to potentially fall asleep. Sidenote: I use the spa channel or classical music to fall asleep at night which is why I can’t really listen to it while studying. And since I also have it preset to have some Irish jig on this channel, I get a happy dance break in-between!

Ipad:

I also have calendar, mail app, and pandora on here. I DO NOT allow text messages or phone calls to reach my iPad. It is a nightmare if you forget to turn it off during exam time. You will automatically fail if it goes off and makes noise, or causes the exemplify app to think you are exiting out to cheat. Really, you can leave it on your phone or computer. You don’t also need it on your iPad and risk your future in medial school.

–OneNote. I’ve posted this before somewhere on this blog. But personally I like using OneNote to take class notes in. Other people use notability. To each their own. I like the ability to have an enormous amount of room to draw/type/import other documents into the same page when I’m taking notes. Again, the downside is if it is a file over 50 MB or something like that it doesn’t import and you have to split it.

–Inkling. This is an ebook platform. We use a fair amount of Mosby series books that go through here. E will usually buy the book itself, and give me the e-code so I can sue it on my iPad. There are a few other similar apps like this depending on which publisher is responsible for the book we are using (such as Kindle, iBooks, etc). Otherwise, I use the PDF version on my computer.

–Examplify. Again, I’ve discussed this somewhere on my blog. We need this to take quizzes and exams through the school. Call it a necessary evil if you will. The recently changed how it looks and boy does it mess me up at times during the reviews.

–Blackboard. Okay. So, I actually hate the blackboard app. I prefer to just login from the webpage. But I do know some people who prefer the app. I’m only putting it on here because blackboard is usually always open on my iPad or computer to watch lectures, download notes, look at grades, etc.

Computer:

I wouldn’t necessarily call these apps. More of what I usually have open on here!

–Blackboard. Always. I can stream lectures better on my laptop because I can fast forward and my computer handles the larger files better.

–Word or a google doc. This is how I sometimes like to fill out objectives. Some classes I find it helpful to go through objectives and see what they want. Others I don’t. Otherwise, everything is just on OneNote.

–Pandora is open in one of these tabs. When I’m not listening to a lecture, I have pandora on playing Lindsey Stirling!

–OneNote. This app uses the internet to save and sync your notes. If I feel like I will be typing more than using the pens, I will use my computer version. Otherwise, I don’t have a computer touch screen, and I will use my iPad.

–Some sort of additional learning tool such as: Teach me anatomy/physiology, youtube, etc., is usually open in a tab if I have and questions and need to source something else. Especially if I forget a book or am still not getting the concept from the book itself. I know I’ve put a lot of different types of websites on here throughout my medical school and COB year(s). For the first part of neuro, I really liked Teach me anatomy. Right now in my second test, I’m really feeling youtube. There are loads of resources to try or see what works.

-Any PDF book that I need that isn’t through one of the many apps on my iPad to view. I also have some books in iBooks as well that I might be able to pull up on my laptop.

And that’s about it. Hopefully this is helpful for some of you deciding on which apps/study materials to use!