Tag: KCUMB

General Surgery Part 2

Yo.

So… when I started med school I really thought I wanted to go into peds. I love kids. They re-energize me. They are fun, and adorable, and I just love them. The parents I could do without most of the time, but give me the kiddos all day every day. And I was 100% ready to be committed to going into peds.

And then my gen surg rotation happened. I thought I would hate it. Despise it. Have a terrible time.

However the complete opposite happened and I ended up having a mid-life crisis of sorts. I was at a fork in the road; a fork that wasn’t supposed to be there but somehow appeared, and now I had to make a choice. Turn left, and continue down the path to peds. It would be a comfortable option for me. Or turn right and go down surgery. It would be more challenging in many aspects. Many people kept telling me to think of the lifestyle that I would have (or lack there of) as a surgeon.

So I decided to use my two electives in third year to help me decide. NICU rotation (I thought I wanted to be a neonatologist) and general surgery again. Welp… turns out the OR is much more my speed.

Rural Vs City

Hmm… so I didn’t actually get to be in the OR when I was a scribe in Michigan. But the surgeons who I worked for in the office had a very narrow subset of things they would see and do surgery on. I’m assuming when you get to cities, since that is where most of the sub-specialties are at, your window of what you see is very small. You’ll be the best at it, but it’s still a small window.

Even in Springfield, MO where I do most of my rotations are similar to this. Which, is crazy to me because Springfield isn’t big enough to be a city in my eyes. More like a suburb. But out here it is considered a city. And with that, there are way more subspecialties for surgery. The general surgeon I was with mainly did gallbladders, appendectomies, hernia repairs, and peritoneal dialysis catheters. Occasionally lipoma removals and I think he removed one adrenal tumor. But overall, not a ton of variation. Sure, each case had small differences which made them interesting, but the same none the less.

In rural, the general surgeon does just about everything. There is no subspecialty. So I got to also see port placements, colonoscopies, EGD’s, bowel resections/surgeries regarding the bowels, examinations under anesthesia, hemorrhoidectomies, and a whole bunch of other cool stuff. Oh, and there isn’t an age cutoff. Got a 3 year old with appendicitis? No pediatric surgeon available- you do it. Anything that my preceptor couldn’t handle got shipped off to the nearest city.

Not to mention all the excisions and biopsies you get to do in clinic in a rural area!

Community vs Academic


I think when most people think of medicine they think of Gray’s Anatomy. It’s a big teaching hospital. Lots of shit happens.

Academic medicine tends to be more like that (but obviously different because Hollywood doesn’t work with patients). You have large hospitals. Many floors/units and patients you are in charge of. You have several subspecialties and sometimes the lines get blurred but mostly not. Several different attending have studies going on so you can do some experimental shit. But mostly, everything is taken care of by residents. It can be crazy or it could be dull. So far in my fourth year most residents sign up for a case or are assigned cases via the chiefs in charge of that team. If they need help another resident is called in. For some locations, there weren’t a ton of students so despite being “academic” you had your choice of surgeries you could assist in. At another place there were several students and you did have to communicate with other students to get surgeries to see. Being a 4th year means you get to basically pick and choose where you go (even though there are some very annoying third years who don’t understand that their shit DOES STINK and they are not in charge but whatever, not my time or place to put humble them).

Community still has a strong teaching aspect; but since there are less residents and specialties, that means you do it all as the resident or student. Since I was in a community hospital, it meant that either I did it or the PA did it. There was no resident. And if the PA wasn’t there, the attending themselves did it. I know a lot of people who are from larger populated areas dislike community places. However this is where you will likely get the most hands on. You don’t have to share. You are taught literally everything. And you’ll have way more one-on-one time with your preceptor or their PA/NP and they will teach you all sorts of shit.

Other important shit


I talked about sterile fields in the last one. That is still important and should never be forgotten. But there are other things to learn about.

  • pre op evaluations
  • suturing and removal (same with stapling)
  • CT scans/tests and how to read them or when to get them
  • wound vacs
  • dressing wounds
  • ileus and how long to wait/when to push to start trialing oral intake
  • post-op complications
  • knowing when something isn’t surgical or shouldn’t be operated on

The list goes on and on here.

But really I just wanted to point out some differences that I’ve seen in surgery. I will say the more medical heavy specialties don’t necessarily change a ton based on rural vs city and academic vs community. It seems to me that your patient load changes not matter where you are, how big your hospital is, and how many residents you have on your team to follow. For surgical specialties, there is the added OR time that changes how things are and how many sub-specialties are present to divvy up the work.

Obviously, no matter what the specialty if you are in a program/place with less people and resources you will be doing more yourself. End of story.

Anywho, hope this was eye opening. I’ve been adding to old posts that I’ve started in my third year quite a bit and cannot for the life of me remember what else I wanted in this post so I’m just going to end it here. Cheers!

Residency Interviews!

Alrighty! You asked and I’m delivering. Actually you didn’t ask but I’m delivering anyways.

You welcome.

Residency interviews are a bit different than medical school interviews. It isn’t trying to convince someone why you want to do medicine and why you have the determination and persistence enough to succeed as a doctor. No. You’ve already done that.

You did your time. You’ve shown you can make it through medical school.

Now it is about trying to find a program that fits well with you and if you fit with them. Sure, some places weight board scores heavily. NRMP director’s report tells you how residency programs tend to weigh/prioritize your application responses. [Go to page 10 on this report; there are multiple charts you can look at for this information.] Other data from the match site itself is available for you to look at as well. But overall, doing a sub-I/audition can make or break your ability to get an interview especially if you try and get along at that institution.

They want to know typically more why you want to do that specialty. Sometimes why that program, but mostly why that specialty. Can you show you are passionate enough in the way you answer/speak about the specialty? Other than that, questions can range to nitpicking apart your application to just wanting to get to know you to see if you are a reasonable and likable person. Remember, you are about to work with these people very closely for 3-5 years (in most cases, unless you do neurosurgery…). They need to know you are a hard worker, can take direction and be taught, and get along well with others. Can you handle when people get upset? Can you take direction from a resident above you in their training even if they are younger than you in real life?

All of these questions are things that need to be answered when a place is interviewing you. Again, residency is more about the fit between you and the program. Whereas med school was more about can you succeed if we take a chance on you.

What an Interview Day Looks Like:

I have asked a few students to tell me how their interview days were across a few specialties. In general, it seemed like medicine interviews were longer days with many more individual interviews, whereas surgery tended to be shorter days/interview times and with either less people or you would interview with many people in a room with you.

These responses are based on the average/overall from several interviews during their application cycle. Each interview likely ran different, even if only slightly. Please take this into consideration with their responses.

From someone applying ENT:

  • Interviews were usually 30 minutes maximum.
  • If you did an audition it could be as little s 10 minutes for an interview
  • In this case, residents also interviewed by hosting breakout rooms. This individual had interviewed with a chief and/or two junior residents this way as well

From someone applying Ortho:

  • Interview day usually lasted 3 hours to half a day.
  • An average of 5 interviews the day of with different people, one of which was a chief resident or another senior resident

When I applied general surgery:

  • My shortest interview was 10 minutes. My max interview was 45 minutes.
  • 2 of my interviews (as these were virtual) had myself and several people all in another room or connected from different rooms. There were a range of residents present on my interviews (including chiefs) and several faculty members and the PD.
  • The one place where I interviewed in person, I had 3 separate interviews ranging from 10 minutes to 30 minutes.
  • One interview had second years available for us to answer questions about the program in-between people interviewing.

Internal medicine (from several students):

  • Some places gave an itinerary for the interview day
  • Interview days on average seemed to be half a day or somewhere between 4-5 hours.
  • Range of interviews from one student: 2-8, another: 3-5, and another: 2-10.
  • Interview times with individuals would range between 15-25 minutes amongst the answers given.
  • Some students also attended morning report and noon conference on their interviews.

Number of Interviews Per Specialty for Successful Match:

Now, this doesn’t mean you won’t match if you don’t get this many interviews. This is just the average. I have personally known cases where someone has only had ONE interview in their specialty of choice and had matched there. They worked their ass off at that audition, but they matched with only one interview. It is possible; it is just not the norm or commonality.

I only had 3 interviews for general surgery. Again, I am a DO, and I had shitty board scores. 2/3 interviews were at places I auditioned at. One was a DO specific program in my home state.

Probability of U.S. DO Seniors Matching to Preferred Specialty by Number of Contiguous Ranks

Specialty80% Chance of Matching90% Chance of Matching
Anesthesia69
Dermatology68
Diagnostic Radiology69
Emergency Medicine68
Family Medicine46
General Surgery911
Internal Medicine46
Interventional Radiology79
Neurology46
Neurosurgery20 
OB/GYN912
Otolaryngology79
Orthopedic Surgery68
Pathology15
Pediatrics45
PM&R812
Plastic SurgeryNo data availableNo data available
Psychiatry810
Vascular Surgery34
Data provided to me by my school’s residency coordinators. Not sure how up to date this is.



Prepping:

So, just like with every other interview you need to prepare. Again, just like my medical school interview, I didn’t do a ton of prepping. Because let’s face it….. I like to fly by the seat of my pants. However some people spend an entire week prepping.

Things you should do:

  • Review your personal statement/familiarize yourself with it
  • Review your application. What did you put on there for experiences? Do you remember your scores? What did you put under about me/what you like to do?
  • Look into the program you are applying at. While some of your interviews may be at programs that you randomly applied too, make sure you get the underlying gist of the program. You will need this to ask questions. They may also ask you why that program.

I’ve had questions asked about all of these to me. So at least review what you put. It won’t hurt to refresh your memory and give you good ideas of things to talk about. Some of my interviews were very by the book like this and they straight up asked me to confirm things/expand on my application what I put. Some really just asked me random things/wanted to get to know me.

I have put some links that I used to prep. There were definitely curveball questions at one site that I wasn’t expecting and no amount of prepping would have helped.

Common Interview Questions

110 Residency Interview Questions

100 more Residency Interview Questions

A common thing I was asked was to explain my poor board scores and how I planned to improve my scores in residency. Some places just wanted to know I had thought about a plan to improve. Since my board scores were my weakest part of my application, this one was asked at 2/3 places I interviewed at.

THINGS YOU SHOULD NOT BE ASKED:

Yes, actually. There are things that they cannot ask you (but try to anyways because they are pricks) and shouldn’t ask you. I found a blog post interviewing another physician on these types of questions and different ways you can answer them. This post/blog is very woman-centric but the information in this post is very good.

Here is a study done on what questions were asked and the percentage that was asked. Very interesting read. Titled “Potentially Discriminatory Questions During Residency Interviews: Frequency and Effects on Residents’ Ranking of Programs in the National Resident Matching Program.” Honestly, I would have picked a shorter title but whatevs.

Tracking Interviews:

As a suggestion from another fourth year, she recommended keeping an excel sheet/google sheets document with dates of your interviews and zoom links. Along with other information. This way, you don’t need to panic trying to find the one email in your inbox with all this information on it. You can also organize it in a way that makes sense to you.

Additionally, if you are lucky enough to get multiple interviews or more than you feel you need, you do not need to take all of them. Make sure if you did auditions there you do try to interview with them (as you did take your time to go to their program). But if you feel you have too many or there are programs that you threw your application into the wind at and just aren’t feeling it, you are able to decline their interview offer.

Wardrobe:

At this point you should know how to dress professionally. NOT BUSINESS CASUAL LIKE WHEN YOU WORK AT AN OFFICE. Needs to be a suit and tie for men. And a suit and/or appropriate work dress with suit blazer for women. Women should wear nylons or tights if wearing a skirt/dress. Otherwise, I think you can figure this out.

In Person vs Zoom?

So, I preferred zoom just because I didn’t have to travel back to a location that I did a rotation at and it was easier. I had a slip-up with one of mine due to time changes and let me tell you I was glad I was already home. Straight up threw on a blouse and suit jacket and left sweatpants on. You know… classy.

Zoom will save you money on traveling and time. But if you are able to get an interview while rotating there in person I do think in person is the best way to gauge a program. You get to physically feel the room and how things are going. Plus, while there you’ve either been working there or visiting there and you get an idea of the program and people itself. Hard to do over zoom.

Call Schedule

Make sure you ask about this. It is appropriate to know several things since you will be a resident there. If the call schedule seems wayyy to hectic maybe not the program for you. You are gunna be run down and tired as a resident. No need to make your life harder if the call schedule is insane.

  • How often do you have call?
  • Do you have a post-call day? Or are you expected to work the entire full workday following call?
  • Is call based on nights vs weekends, is it a full 24 hours, etc.
  • Do you have a buddy system for first years?
  • How many teams are you responsible for during call?


QUESTIONS TO ASK YOUR PROGRAM

These questions are by far going to change based on location/program/and specialty. These were mine. You can add/delete/change things for yourselves and obviously you need to ask questions that will work for you and your specialty. Again, this is just to help you out if you are stuck. I do recommend if you are rotating there you will come up with questions while you are there so make sure to have a list. If you get offered an interview, ask the most pressing questions you want to know during the interview. Usually 1-3 are fine per person/group of people. The rest ask the residents.

  • what % of graduates that pursue fellowships get accepted?
  • any global health opportunities?
  • How frequent are residents required to travel to other cities for rotations? (If they have other locations this is something to ask).
  • what opportunities are there to practice my skills outside of the OR? I.e. skills labs?
  • what are you doing to improve the program?
  • what advice to you have for me to succeed in this position?
  • early intra-operative experiences?

Hope this was helpful and good luck. Cheers!