At the end of my 2nd year medical school there was a tremendous amount of stress in my school created by both my classmates and myself. We were all making the transition from the classroom to the clinical rotations. This may not seem like such a big deal to most people. After all, most people go straight into their job once finished with schooling. However, this was especially difficult for all of us because we are students who have excelled in the classroom for the past 18+ years of traditional education. We now had the task of going into the real world and finding out if we really will succeed in the way have been told for nearly 2 decades. No longer could we hide behind the glare of our computer screens or buried in a textbook. We would have to face real life doctors and display what our formal Education had taught us.
Now that I am an attending surgeon I see the stress of the students who rotate with me. The surgery rotation has the reputation of being quite demanding. It is demanding because medical school does not necessarily focus on surgical education but rather general medical education. Surgery is foreign to most students. Unfamiliarity, long hours and the stereotypical surgeon being crass but also intelligent usually strikes fear into students. The aim of this post is to alleviate some of the misconceptions of surgery and provide some basic advice.
It has been my experience that students will tend to over complicate surgery. I will provide an example. Recently, I was discussing a patient who had diverticulitis that had a microperforation and abscess. In rare instances a colon cancer can present in the same way. We were able to successfully treat the patient with antibiotics. I presented a question to my student. How can we be sure that there is nothing more than diverticulitis causing the presentation. The simple answer that I was looking for was to perform a colonoscopy on the patient in a few weeks after the inflammation has gone away. The answer I was given was a very detailed differential followed by an exhaustive workup for many rare conditions. I was impressed actually. After I rephrased the question and told her to step back and think of simple things we can do, she readily came to the conclusion that a colonoscopy would be a good idea. This is just one example of how we can overthink a surgical problem when the solution is often times simple. It is my interpretation that students often times think the answers to posed questions are much more complicated than they are. I do not want to suggest that knowing all of the information that she originally presented to me isn’t important. It is. However, the big picture of a clinical problem should be our guiding force.
One of the easiest ways to alleviate anxiety is to be prepared. This means arrive early, know all objective and subjective data regarding the patients that you are assigned, and be prepared for the cases of the day. A little bit of preparation goes a long way. It is very obvious when a student is not prepared. The expectation is not to be proficient in surgery but it is really hard to teach someone that does not have a good foundation of knowledge. The surgeon will have more time to teach the more complicated aspects of surgery if you already know the basics.
There is a book called NMS casebook. it has been around for a long time but it does a great job with the basics. This book in addition to a good question bank is a really good place to start. Once the basics have been established, I strongly recommend reading a good surgical text. Sabiston’s is a nice way to start for a medical student. Some people may say that this is too in depth for the medical student but I disagree. Links to each book is provided below
The last thing and a secondary goal of the surgery rotation is to determine if you would be happy in a surgical career. This can sometimes be difficult to figure out. Keep in mind that the student is shielded from many aspects of the career in surgery. Observe the surgeon and surgical team. Are they happy? Does it look like a lifestyle that you would be interested in living? It is also important to determine if your personality matches up with the people in the profession. The career tends to self select people who are a good fit. This is not a concrete rule but listen to your gut.
Opereight 