Post-Surgery Rotation Update: Intro

Greetings, friends! I know it’s been a while since my last post…I’ve had a ridiculous amount of things to do since March.  But now I’m done with surgery!  Took the shelf exam yesterday and am now at home in Memphis with my family for the weekend.

The following posts sum up what I’ve been up to in the past 8 weeks.  There’s a lot to discuss, so I broke it up into brief “installments” instead of trying to talk about everything at once.  I’ll discuss separately my experiences on a subspecialty, a general surgery service at the VA hospital, and two “transplant” services at Vandy, as well as other things in between.  I’ll also include a post about studying and taking the shelf.  As always, feel free to leave questions or comments on any of these posts and I’ll get back to you.

For reference, here’s what a typical day looks like for a med student on surgery at Vandy (with the exception of the subspecialty):

  • Before morning rounds happen, med students on most services are expected to “make the list” of inpatients currently under the service’s care, record fluid and diet intakes and outputs, and copy all of this information for distribution to the rest of the team.  They’re also expected to “pre-round” on patients whose operations they were scrubbed in on, or patients whose care they were involved in somehow; pre-rounding includes talking to the nurse about acute events, looking at recent labs and vitals on the medical record, talking to the patient about how s/he’s doing, and performing a focused physical exam.   Morning rounds usually happened at 6am for us, which meant getting to campus pretty darn early (as one of my advisors says, “0-dark-30”) to take care of all these things beforehand.
  • During morning rounds, med students present the patients that they pre-rounded on, relaying acute events overnight, pertinent exam findings or lab values, and a potential plan for that patient.  Presenting, especially coming up with a plan, always made me a bit nervous, so I liked to give myself extra time in the morning to think everything through.
  • After morning rounds, the scheduled operations start, as early as 7:30.  If there’s not an operation to scrub in on, med students might help interns take care of “scut” work: pulling drains and lines, changing wound dressings, etc.  The exact nature of the scut depends on the service.  If there’s no scut to take care of, then it’s a good time to pull out a book to study until someone needs help doing something.
  • If there is an operation to scrub in on, the med student usually goes to the patient’s pre-op holding room with the resident who is scheduled to help perform the operation, just so s/he can properly introduce him/herself to the patient beforehand.  Then it’s off to the OR once the case starts.  In the OR, during the case, med students are often asked to hold instruments, suction areas that are bleeding, help close incisions at the end of the case (i.e. suture/sew stuff up), and by all means not contaminate anything.
  • There are also designated times for outpatient clinic.  The nature and duration of these depend on the service.  Sometimes I was in clinic all day with the residents and interns, seeing patients, presenting to my superiors, and writing notes after the encounters; other times I simply shadowed a resident for a few hours.
  • Both in the OR and outside of it, surgery residents and attending physicians are fond of “pimping” medical students.  For all you non-meds out there, pimping is when someone asks you questions about anything from surgical techniques to anatomy to drug mechanisms of action; if you get the answer right, you feel pretty good about yourself and the fact that you studied the right pages of your textbooks that day, but if you don’t, you might end up feeling foolish (personal experience).
  • Other than that, there are often conferences, afternoon rounds (much more low-key than morning rounds), and the occasional moment (or stretch) of down-time.
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