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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.

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…

Life As a Medical Student

Hello hello.

Whether you are a premed interested in what your future may look like in medical school or you’ve recently been accepted, finding out what a day in the life of a medical student looks like is often something searched. It is usually difficult to find, and for good reason! Every school, curriculum, and student is different. Making a “day in the life” of student hard to capture.

I am going to be honest here: I was not usually on top of my shit as a student. Despite what the medical school youtubers show you and what the over-achieving instagramers say, most people are not on top of studying or have it together in medical school. It is completely common to be far behind, too tired to finish, or often run out of time in the day to do what you need to do.

Because of this, I spent a lot of time NOT going to class, learning at my own pace, and sleeping. Majority of my classes were not mandatory in person, and they were recorded so we could in essence “re-watch” them later. What that really meant was most students didn’t go to class and just watched them later on their own time.

Year 1:

Year 1 is all about that learning curve. In case you haven’t read a previous post, I went to a school that was known to have a difficult curriculum. They also had block scheduling, and the curriculum taught the “normal” first year and the “abnormal” second year. So that meant first year you would have anatomy, physiology, biochem, immunology, histology, and embryology for each section. The second year was mostly pathology and pharmacology. So you would have GI 1 in first year covering the basics, and GI 2 going over disease and pathology. They would definitely throw in common diseases to be tested on in first year though; they make great test questions. The idea was that you would have the ability to see it twice; as more repetitions = more likely to get into your brain.

Because the school was proud to have a “tough curriculum”, it also meant that you did a lot of self learning. I won’t go too into details, but you would have your lectures/reference books, but a lot of it was not easily put together for you. You did have to hunt to find important information. First year did hand you a bit more, but by the time you got to second year you did a lot more hunting…

It definitely made it frustrating as a student as most of us wanted to spend them time just learning and understanding what we needed to know, but it is what it is.

I wrote a lot of blocks on my classes in first year. But a schedule typically looked like this:

Class from 8 am to noon most days of the week. Occasionally we would have lectures in the afternoon, but most of the time we didn’t.
Lab usually from 1-4 on 2 or 3 of the days in the week. First year would have PCM, OS, and anatomy labs to fit in during the week depending on the block course you were in. OS and anatomy labs were 2 hours, PCM was only 1 hour.
Any additional time spent off was in the lab or studying for your courses.

This meant that you either had to pre-read/review lectures before class and try to learn a chunk of it during class, or do most of your reviewing later in the evening. I am more of an evening person, so most of my studying occurred at night.

For most labs, you did not have to prep. But for some you did. This obviously took up some of your review time to make sure you were prepared. There were a lot of long nights and most of my weekends were spent trying to catch up simply because of this. As time went on, I stopped going to class to sleep in or try to start studying and just went to campus for labs. For anatomy, you spent most of your time trying to dig and find your structures, but you didn’t learn them well until they were cleaned out and you were able to see them and their relationship in the body. If I would have prepped more before going into lab, I probably would have gotten more out of it.

Our school has something called Mediasite, which is where our recorded lectures would be. They would show up as soon as the in person class was finished. We could speed up or slow down the lectures, so you could get through lectures pretty quickly if you wanted. Other schools I know utilize just voiced over powerpoints, which you cannot fast forward through…

And that was how my first year went. A lot of lectures, doing questions, trying to learn the anatomy, etc. There were some classes that I utilized a lot of additional resources besides my notes, and some where I didn’t need to utilize much. Because I had previously had plenty of exposure to the subjects taught, I knew how to study for them and how to approach them. It was just learning how to accept, study, and understand the large amounts of material in a much smaller amount of time.

Overall I would study an average of 10-12 hours a day first year.

No, I didn’t really work out.

Yes, I had a lot of anxiety and there was a lot of stress burrito-ing happening and cuddles with my kitty.

Year 2:

Honestly, more of the same. Except the focus was on pharm and path. I utilized Robbins path and pathoma the most, in order to help me understand and organize the material better. But honestly, you just have to see the material many times in order to understand path.

We didn’t have anatomy second year, so our only labs were OS and PCM. Most of the important skills we actually learned in first year; so a lot of it was review or integrated with some fine tuning. Since we had exposure to how they tested for different scenarios for both courses in first year, it wasn’t as stressful second year.

For our schedule, it was similar:

Classes 8-12 (or less depending on the day)
and lab/simulations about 2-3 days out of the week. We rotated in smaller groups for more things, so the schedule would look more hectic than it was.

Again, I chose to sleep in during the morning and get a later start to classes/studying than go to class. I simply didn’t learn in class. And if I did go, I could only pay attention for about an hour before I needed to switch. Plus, a lot of our path/pharm lectures were flown through simply because there was so much material and not enough time to teach it.

I’d say I utilized more outside resources consistently for second year, such as Truelearn for questions, or sketchy/pathoma for help with path understanding. So instead of multiple books, youtube, paid resources, etc, I just used the same 1-3 sources. First Aid can also be utilized as well to help organize your thoughts for path.

Then towards the end of the year you start gearing up for boards and dedicated. See my other posts for that information.

Overall, I would study maybe 6-8 hours a day consistently for second year. Partly because I was burned out, and partly because I would avoid my duties due to stress. It is what it is.

No, I still didn’t work out. I did hang out with friends more though. We would call it “study group” but only about 1/2 the time was spent studying…

Year 3:

Well, I’m just starting so I don’t have much to offer yet!

But my site is doing what they call the “2+2” method. It is where we are in clinic for 2 weeks and then off for 2 weeks. But when we are on, we are on. In my first rotation this meant I was on straight for 14 days. Anything that was on call that my provider called me for meant I needed to be there. It was a bit exhausting by the end. I didn’t really get a “day off” until my 14 days were done.

I know in the future, my schedule could be any combination of weeks on/off. It just so happened that my first rotation was one off, two on, one off. Because of this program, we have more work to do than our classmates. We all have some online work to do (and by we I mean my class as a whole), but my site has more additional projects that count towards our grade. This includes case presentations, powerpoints, standardized patients, and virtual reality.

On my weeks off, it would usually consist of doing the work assigned for a grade, flash cards, and practice questions.

For my first rotation, my scheduled looked like this:

6am Rounding: As a student I would go before clinic started. I would usually run into my attending as I was finishing up so I could present. Then we would go see the patients from there. If I finished beforehand, I would look up the first few patients in clinic for the day so I had their information handy if I was sent in to see them.
Clinic from 7am-4pm (which always ran late).
I was on call the whole time, so if anything next door on the floor was called in, I would leave clinic to go be with the attending that was dealing with that. Sometimes it was the attending I was with, sometimes it wasn’t. Weirdly, I was usually with the attending in clinic that was on call that day. So it worked out in my favor. So if a baby was about to be born, we would leave clinic and go deliver and come back.
Some days we would have scheduled surgeries mid-day. So usually over lunch?
After clinic, we would visit patients on the floor. Usually started sometime after 5 pm. We would check in with any mom’s that needed to be delivered, or anything that was admitted while we were in clinic.
I would usually leave anywhere around 6-7 pm.
On the weekends I would be there from 6/7am-7pm. I think there was one night where a case went haywire and we were there pretty late.
This was a mix of inpatient and outpatient.

And that was mostly how my first rotation went. I only had enough time to shower, make food, and eat before passing out during the 2 weeks I was on. And since it was my first rotation, I hadn’t learned how to work in studying yet and hadn’t gotten used to the physical exhaustion yet. Hopefully my next rotation I will be better with this!

All I know is my next rotation is peds. I’m off the first two weeks and on the last two. I believe this rotation is just inpatient, so I’m expecting to be doing regularly scheduled 12 hour hospital shifts, but will let you know!

Cheers!