KCU-COM 2022 – We're All Med Here

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.

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.
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.
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.
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.
No arms above your head! I learned that the hard way.
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.
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.
I recommend watching the surgery team fully set up a patient a couple of times so you can see how it is done.
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…

Endo/Repro II

Hello!

I had to take a break during our last block (GI) for personal reasons. Which is why I didn’t put anything up study-wise for it. But I’m back into the swing of things and trying to grasp how to best tackle this information. I’m trying some new study techniques this time around! Although honestly, it feels like I’m always changing up my studying style with each block…

Path is always my worse subject. I don’t normally understand it. There is histopathology and small random facts/clues that don’t seem to correlate. They don’t solely test us on histo pictures anymore in second year, but in general it is a difficult subject that I need multiple exposures in order to start grasping.

Here are some ways to go about it:

1. Reading Robbins. I personally hate this one. I don’t absorb what I’m reading. Even if I feel like I understand that half page I just read, I will completely forget it when I move on. But if you absorb well from reading, this is one way to get the material into your head.
2. Previous outlines of Robbins. We have a prior KCU student that outlined the chapters in Robbins. Complete with fancy charts, some highlighted information, bolded important information, and sometimes they go back and add in prior high yield test/quiz topics. This is what I have started using as my first pass.
3. Lecture. Now, I dislike this method, but it does give me another pass and I use it to point out what the professor deems important. Sometimes the professor will actually teach, other times they just say “know this” and list a bunch of crap. It’s up to you how you best learn, but I have heard from many of my classmates that they at least listen to lecture on 2x speed just to star the topics the professor highlights in lecture; especially if they don’t really teach. Unfortunately, there are some professors who don’t touch on some topics in lectures. But because they are in the book, they write questions on it (even if they didn’t go over it…)
4. Pathoma. I recommend if you are having trouble understanding the basic concepts or even just getting a good organizational start on the material to go with this. They are short, sweet videos with accompanying high yield points. It does not always correlate in order with Robbins though.
5. You can use sketchy path as another way to get information in. I know classmates who prefer using this since they already have it from micro and pharm. I personally don’t like using this for path, but it presents information in the same way it does for micro.
6. Learning objectives. I’m hit or miss on this. Sometimes in path I will use this to help fill out the information; others I don’t. For path, basically every learning objective is a header in the book or a chart. So you have to know all of it anyways. But for other disciplines I find learning objectives helpful.
7. Practice questions. In general is usually helpful. But sometimes you get too used to the way questions are written by the authors of the practice questions instead of your professors. Just be mindful of this!

My way:

1. I first use the outlined notes. I print them out and underline, re-write, whatever it is I need. I go in smaller sections and have my book open if I need clarification or need to write it slightly differently for my brain to understand it.
2. I then go over this section of notes, either by writing it out or using a write board. Can I make associations with the material? Can I define the disease? What are the prominent features I need to know? Buzzwords? You get the idea. I don’t do this for all the pages, but it does help with some of my sections. Occasionally I’ll make a chart if there is a lot of information that I need help picking details out between. But I have not been doing as many charts as I did originally for GI. I may also decide to make organizational flow charts or “mind maps” as well. What’s the main, overarching subject, and what falls under it? Sometimes just reading the book or reading the outlines it is not as apparent.
3. I then listen to lecture to get the points of what the professor deems important. I either have the lecture up or the book open, and take notes either in my margins & highlight in the book, or I put it on my iPad.
4. Notecards. I don’t normally do well with this, but I’m finding that I personally need to increase my exposure to remember it. Just because I understand it before bed the night before doesn’t mean I will remember much the next day. There is a deck that a previous KCU student made that I am modifying/using in Anki. I also add my own cards as well. But you could use any prior deck, make your own, or use a Zanki deck. A lot of students recommend running notecards before bed. I have trouble with this as either the notecards aren’t finished, or I don’t feel confident enough in the material to start using notecards and it causes more confusion for me. If this helps you, then utilize going through them before the end of the day.
5. Pathoma. I use this basically if I am super confused or want to test my own knowledge. It is just another way to expose myself and see if I am making those connections.
6. Practice questions. Really a crucial part in seeing if you understand the material. I’ve mentioned in other posts what practice questions can be helpful. In general, Robbins questions, university of Utah path questions, and/or Truelearn (COMBANK) questions can help.

For Clinical Medicine & Pharm:

I am doing something completely different than what I have ever done for these. Simply because I need to get more on top of the material. Again, if you are like me and you need to see the material 8,000x before the exam, then see how I am doing it. Otherwise, do what you are doing boo.

1. Pre-reading lecture OR filling out objectives the night before. I am doing this basically to set my notes up and to help get exposure. I then print them out so I can write all over them.
2. I actually go to class for clin med. Or as many as I can get up for. I really enjoy the repro clin med lectures, so it is fun to go for me (I know, weird). I am more apt to pay attention if I have an inkling of what is going on (hence the notes the night before). I add in anything to my paper notes that I missed from the night before, that the professor deems super important, or any questions they give us in class. There was a few times I didn’t go to clinical med lectures. In which case I still did my notes before hand and then just watched the lectures.
3. Reviewing this by both reviewing my LO’s and flash cards. Same principle here; I need to see it a lot.

In a previous course I would make giant charts for pharm. I still have charts in my notes, but they are based on the learning objectives.

Is this a lot of work? Yes. Absolutely. Do I want to pass? Yes. I’m finally a bit more motivated and want to do well. I feel like I have wasted my time in medical school not being able to fully grasp the material. Which is due to a multitude of things, but I digress.

As you will see, a lot of second year is learning on your own. You and Robbins are going to be the best frenemies you’ve ever had in your life. It’s a love/hate relationship that you will be ecstatic to be rid of after boards. But until then, trying to find a good way to synthesize a lot of the material and connect the dots is key in second year.

Another big thing (which I can’t help you determine) is:

Are you a fast or slow learner?
Do you synthesize well by reading or do you have to write it out?
Can you just look over the powerpoint and grasp information or do you need to put it in a different format?
Do you do better with learning new material in the morning when you first wake up or reviewing when you first wake up?

All of these things will help determine how you will be able to best learn the material and approach it based on your brain and your learning style. There are more questions you could ask yourself, but these are some of the ones I’ve come across while attempting to figure out my learning style.

See, in first year, everything is very piece-meal. You either know it or you don’t. You can easily break it up by discipline or by LO’s and not a whole lot interrelates with each other. In second year, you don’t get that luxury. So it is a bit harder. It also seems like the professors teach less second year than they did in first year. So there is that too..

TEST 1: Repro

64% clinical medicine
27% pathology
9% pharmacology
Total: 100 questions

Overall, I would say it was a fair exam. There were some very easy first order clinical med questions, and some very difficult questions. Pharm was if you knew it, it wasn’t that difficult. But if you didn’t you would have to guess. Most of what I felt I got wrong was on the path side, simply because I didn’t have enough time to learn all of the very nitpicky details. But that’s okay! I’m overall very very happy with my raw score for once. I will have to wait for our official scores to come back and to see my specific exam breakdown to see what areas I may need to spend more time on in the future.

Average: 76%. Much higher than our other exams! Our clinical medicine average was pretty high. However our class path average was around a 66%. So ya know… that’s cool.

Test 2: Endo

10% of this exam is from our repro section by the way…

Pathology: 43%
Clinical medicine: 29%
Pharm: 19%

Review from last test:

Pathology: 2%
Clinical medicine: 6%
Pharm: 1%

Total: 70 questions.

Overall, it was a very fair test. I just frankly had a really hard time studying as it was the end of the semester and we had a lot of other exams going on. I did less studying for this particular test because of all the end-of-the-semester crap. But since I had a better idea of how the material was presented given the course directors and the previous test, I cut back on what I did to study.

The pre-made notes by a former student were not done for the endocrine chapter. I ended up reading and making my own. Somewhat helpful. I made myself more charts/compare contrasted to help learn some things.
I utilized the powerpoints heavily as the professor teaching pathology had most of her information in her slides. I did watch her lectures as well for another pass.
For pharm, I wrote out/drew some of the physiology pathways and where the drugs blocked this pathway. It helped me learn them tremendously in this section.
Clinical medicine I just reviewed our high yield handouts. Most of what was covered in clinical medicine was a review of sorts for pathology. So the main focus was on treatments for these diseases and what lab tests you would need to identify them.
I did review more of the CIS questions which helped a lot.
I did not do as much pathoma or flash cards for this section

Average: 83%. So much better!

Anywho, I hope this helped in directing some of your studies for endo/repro!