Clerkship Review – Surgery

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Surgery is arguably one of the more difficult clerkships in medical school. It is characterized by long hours and requires not only knowledge of medicine and surgery but also technical skills to assist in surgeries. In this post, I reflect on my experiences rotating on the vascular surgery service at the VA hospital and the burn service at Hillcrest hospital in La Jolla, CA. I also provide some advice about practicing your surgery technical skills and preparing for the shelf exam. Full disclosure: I am not, and have never been, interested in specializing in surgery. I went into this rotation with the mindset that I would probably never step foot in the OR again and that I would put my all into the rotation and learn as much as I could.

 

Vascular Surgery

I enjoyed vascular surgery because it requires a fair amount of medicine in addition to surgery. Many of the patients on the vascular surgery service were complicated patients with chronic conditions (e.g., diabetes, cardiovascular disease) that the surgeons had to manage in addition to their acute chief complaints. Thus, I learned quite a bit of medicine and surgery during this rotation.

Some disadvantages of doing vascular surgery from the perspective of a medical student are the low volume of patients and being unable to participate in the placement of stents in the extremities, which is one of the bread-and-butter operations for vascular surgeons. Oftentimes, we only had one or two patients on the service; sometimes, we had none. When we did have a patient, most of them needed to have stents placed. However, I could not participate in this procedure because there is limited space around the patient; thus, I spent most of my time in the OR passively watching the surgeons deploy stents on a screen.

 

Burn

I enjoyed the burn service because I got to participate in integrative care of pediatric and adult patients. Burns are painful and disfiguring and require long hospital stays and rehabilitation. Thus, the burn service is a fully integrated team that has not only burn surgeons and nurses (who perform skin grafts and monitor burn treatments) but also psychologists (who treat any downstream psychological sequelae like pyrophobia), nutritionists (who optimize patient nutrition to improve burn wound healing), social workers (who ensure that patients have a safe place to return home), and child health specialists (who help rehabilitate burnt children). As the sole medical student on the service, I participated in every one of these facets.

A disadvantage of rotating with burn was the low variety of procedures. Most of the surgeries I got to participate in were permutations of skin grafts. While the types of grafts would change, the procedure itself was formulaic: debride the necrotic/burned skin until unburnt dermis was exposed and place the graft or dressing on the freshly exposed dermis.

 

Practicing Technical Skills

Surgery is a unique clerkship in that it requires medical students to practice technical skills. The two most universal technical skills are maintaining sterile technique and suturing. It is important to quickly become adept at sterile gowning, especially if you have not had much experience with it before. Your medical school should provide a short tutorial on how to scrub yourself in sterilely and maintain a sterile field. Make sure to introduce yourself to the scrub nurse(s) and become friends with them early on. They will look out for you and help you get gowned and gloved for the OR.

In terms of suturing, you must practice on your own time if you want to become proficient. If you are set on becoming a surgeon, you should spend tens of hours practicing. Make sure to attend any suturing labs that your medical school holds. In addition, make sure to buy your own suturing kit. I would recommend heading to your nearest market and buying some pig’s feet, bananas, and oranges on which to practice suturing. You can also practice your surgical knot tying on the drawstrings of your scrubs.

 

Shelf Exam

The surgery shelf is a difficult exam. Furthermore, the long hours of surgery make it difficult to study while on the rotation. I always made sure to carry Dr. Pestana’s Surgery Notes in the pocket of my white coat wherever I went. This book, while short, is a high-yield resource for medical students on surgery and is written in the digestible form of vignettes. If I had a free moment, I would pull out the book and read a few paragraphs. I also made use of Anki flash decks (I inherited some decks and also looked up a few for surgery). Next up, make sure to do questions from the UWorld for Step 2 CK question bank on a daily basis. There are not a lot of surgery questions, but many of the medicine questions will show up on the surgery shelf. Thus, you need to do both the medicine and surgery questions. Finally, if you have a lot of time on your hands and want to go above and beyond (i.e., you want to get Honors), I would recommend reading de Virgilio’s Surgery: A Case-Based Clinical Review.

 

Final Remarks

Surgery was a challenging but rewarding clerkship for me. Even though I had no interest in becoming a surgeon, I learned so much and was in awe of the skill and knowledge of the surgeons I interacted with. This is definitely a clerkship to look forward to, and one that I will never forget.

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two surgeons operating behind drape; green colored

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