Tag: third year

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!

Applying to VSAS

Hello!

I hope ya’ll are doing well. Ya know, keeping your head above water, staying afloat, balancing how much caffeine gets you through the day and how much alcohol gets you to calm down at night…

Those sorts of things. 🙂

I’m currently trying to wade through third year of medical school. And while not a disaster, is still exposing many difficult and new areas that a student has to navigate through. Not to mention, there are a few additional things to be aware of while going through it; particularly how to get audition rotations for residency.

Towards the middle of your third year you will start hearing about something called VSAS, or visiting students application service. You may also hear VSLO which is visiting students learning opportunities. It is ran by AAMC, but all students (both MD and DO) use this site to connect with hospitals around the US to visit, audition, and try electives in their fourth year that may not be available to them at their home institution.

Your home institution (or at least mine has) will have a certain amount of schools that you will be able to rotate through with on here. This is not the only site you can use to help you find elective rotations or audition rotations. But it is the most commonly used amongst residency programs and hospitals that host students.

My school gave us access to VSAS pretty early on. However you need to be aware that most sites don’t open to taking students during your fourth year until the Spring of your third year. So some sites might not be up there when you look or they have already taken down the application. Some sites are still taking fourth year students for the end of their fourth year. It’s a rolling type of application service, and things change constantly. And since I’m doing mine during the second year of COVID, I’m sure things will get even weirder.

With that in mind, VSAS tends to give students the ability to start uploading their application pretty early once you get access through your school. This is a good thing. A stressful thing, but a good thing. Many classmates I know are putting it off because their plate is just too full.

I understand that 100%, I do. But it is not advisable.

VSAS is a first come, first serve type of service. So even though it is stressful to look up potential residency sites that you want to audition at and start putting together your application, the sooner you have it done, the easier. That way, when your sites open up you can just click the sites you are applying for and pay instead of finishing your application once they open.

Additionally, my school requires 3 sub-I’s/audition rotations to graduate. So my class needs at least 3 auditions to be qualified to graduate. Make sure you check your home institutions requirements.

Now you can do more. You can also choose electives for 2 weeks or just electives in general at another hospital. And you would use VSAS for this as well.

Approximate timeline:

As early as possible:

  • When you get the login information from your school, no matter how early, set it up. It is just easier than remembering to do it down the road. Make sure you can login and everything the school has down for you through the site is correct. Better to have plenty of time to fix it now than during crunch time later!

Third year, October-December:

  • Start looking at potential residency sites that you may be interested in. You don’t need to find all your potential interested residencies in one day! But start making a list.
  • Go to ACGME.com to find the accreditation status of residency programs in your specialty that you are interested in. Here you can cross off anything military (if you aren’t military) and see any residency programs that are on probation or have any issues. You usually don’t want to deal with programs struggling to get re-accredited, are on warning, or on probation.
  • Use FRIEDA to help find more information about programs. This usually gives you the general stats and a contact person. Do not go overboard with contacting the sites. I basically just emailed the sites I was interested in to find out when they would be posting on VSAS and if they were planning on taking students in 2021-2022 year.
  • You can also use Clinician NEXUS and residency explorer tool to look into programs.
  • Start breaking down the list of things you need to upload to VSAS into smaller, more manageable chunks. If there is something quick and easy you can do, then do it if you can.

Third year, January-February:

  • You should be narrowing down a potential list of programs you may want to do residency at. Pick a few of your top choices to try to rotate their. Just remember, you may not get a spot, so be prepared to apply to more places to try to get auditions.
  • You need to be uploading what you can to VSAS. List will be down lower in the post.
  • You should be reaching out to people for letters of rec. Most specialties do not require a letter of rec for visiting students. But some specialties do. When doing your research on programs, this is something to look for. If required, it will need to be from a specialty that you are trying to rotate in, not a letter of rec from anyone.
  • Same with letter of interest. Some sites/specific specialties want a letter of interest of why you want to audition in that specialty. Start thinking about formulating this.

Third year, March:

  • If you haven’t finished uploading everything to my documents, you need to do that.
  • Any sites of interest that have opened up by this point you should apply to.

Third year, April-beginning of fourth year:

  • The rest of this time will be sites opening up for application. You can star places to find them more easily.
  • You will be using this time to find out when the sites accept you, when they are available for you to visit, or reject you.
  • You will use this information to build your fourth year schedule.
What do i need to upload to Vsas?
  • Immunization form and proof of immunizations.
  • Background check
  • Urine drug screen (UDS)
  • ALS certification
  • BLS certification
  • CV
  • Board scores
  • official transcript
  • letter of interest (dependent on specialty)
  • letter of rec (dependent on specialty)
  • COVID vaccination (not currently required, but likely highly recommended)

How do I find the immunization form?

Immunization form can be found here. This is the 2021 version, but if you go to the VSAS site and type in “immunization form” into the search bar it should come up. I doubt it will really change much.

You need to fill this out. Now, there are 2 options: You can fill it out and have a provider sign it so you can upload it (MUCH FASTER), or you can send it in to your clinical coordinator who will sign it and upload it for you (CAN TAKE WEEKS TO MONTHS). I went the provider route. Also, I had to split this document with the proof of my immunizations in two uploads because it wouldn’t upload that big of a file. Just an FYI.

How do you get a copy of your immunizations, drug screen, and background check?

As KCU students, you should have sent everything to be uploaded via SentryMD. They basically keep track of that for the school and send reminders when you are due for things. You should have gotten most of your immunizations before medical school. The background check, UDS, and anything else you will get before starting your third year. At least at KCU you will as these are your clinical years. I’m assuming its the same or similar for other medical schools.

You basically just email SentryMD for a copy of everything and they will send it to you. If you are anal like me you would have a copy of that already on your computer.

How do I get a copy of my transcript sent to VSAS?

Well, you have to go through your school for this one. KCU kids I gotchu, everyone else I hope it is a similar process for ya’ll.

Step 1: Go to the kcu login page. You will need to login with your student ID number and password.

Step 2: Click on the KCU intranet icon.

Step 3: Click the menu on the left hand side of the screen. Select Forms. Then select Registrar forms.

Step 4: Under this, choose student forms. At the very bottom you should find “VSLO transcript release”. Fill this out and submit the form.

Step 5: It took a month for me to recheck to see if this was uploaded. It was not and I requested the upload as soon as I came back from Winter break in early January. What I didn’t know is until you try to send your application to a site, they won’t send a transcript. But it is never a bad thing to reach out and make sure it is uploaded. I just couldn’t see it on my end!

How do I upload a letter of rec to VSAS?

There is a way to do it through ERAS, but you I haven’t figured that out. If you are more savvy than me give it a shot.

Otherwise, you have the person email it to your clinical coordinator and they will upload it for you to VSAS. Make sure you are keeping on top of when your letter of rec writer sent it into your coordinator so you can badger them to do their job and upload it.

What takes the most time to get together?

Honestly, getting your letter of rec uploaded and your official transcript uploaded. And if you choose to have the school fill out your immunization form. Otherwise, everything else you yourself can upload, so you have control over how long it is going to take to get this information on their.

Last thing!

Make sure you’ve also filled out the about me spots and uploaded a picture of you to the VSAS website. It will ask for when you’ve completed your core rotations, when you completed ALS, BLS, and PALs (if you have), and for DO students they ask for your AOA number.

KCU students, if you go to your student 360 portal your AOA number will be on the first page along with the information about you. Otherwise, you can call the AOA line and they will send it to you if you are a DO student and don’t know it. I for sure had no idea I had one.

Anywho, hope this helps on your journey through medicine!

Cheers~