Category Archives: surgery

Post-Surgery Rotation Update: On Studying and the Shelf

As I mentioned before, I took the NBME Shelf Exam on Friday. I honestly went in not knowing much about the test format, other than the fact that it was going to be multiple choice, Scantron-based, 2 and a half hours long, and most likely a fairly random mix of questions–that is, not just related to surgery.

The test was 100 questions long. 100. With extremely long question stems. I should’ve expected as much after having taken Step 1, but even after having done the surgery questions in the USMLE World Step 2 question bank to prepare, this threw me for a loop. A third year told me to make sure I budgeted my time wisely during the test, but I almost didn’t finish. That was partly because I was exhausted from a ridiculous week (I remember zoning out more than a few times), but I’ll definitely have to do better with that next time. Don’t even get me started on the difficulty of the test; I did the best I could as far as budgeting study time, but I don’t know how well my efforts paid off in the end. I was just glad that I put an answer down for everything!!

Speaking of study time: there wasn’t much of it.  Between getting up before sunrise and often going to bed before sundown, there just weren’t enough hours left.  But I did what I could with my off-days and random downtime in the hospital.  Buying an iPad and downloading PDF versions of the textbooks helped quite a lot with this, as did using the UWorld QBank app on my mobile devices.

Now on to study materials.  Unlike Step 1, for which you can probably get away with studying from one primary book and supplementing that information as needed (what I did, although I wasn’t completely happy with my score in the long run), students often stockpile books for shelf studying and try to get through as many as they deem helpful or reasonable.  The question of how to structure one’s study time, whether to read chunks of multiple books simultaneously, finish one at a time, go by page order, by topic, etc, is up to the student.  I tried multiple methods over 8 weeks and have yet to figure out what works for me in that regard; of course, it might depend on the specialty.

I started back in March with this grand study schedule that listed which books I would finish by which dates, but I quickly realized it was way too ambitious.  After emailing some upperclassmen about what books to acquire for surgery, I decided to use about 5 books.  I only got through two of them completely, and only about two-thirds of the way through another.  In the end, I still covered quite a bit of ground page- and topic-wise, but I’m not sure how efficient that time was (I’ve never felt like I retain that much when I read).  In any case, these are the books I used and what I thought of them:

  • First Aid for Surgery: pretty much a mainstay for this rotation, but it’s an overwhelming amount of information.  Best to start early and take it in small chunks if time allows.
  • Casefiles for Surgery: 56 cases and discussions of workup, labs, and treatment.  People either use this book or NMS Cases (whatever it’s called, I didn’t touch it but maybe I should have), sometimes both, but one of them for sure.  I found Casefiles pretty useful.
  • Surgical Recall: ABSOLUTELY NECESSARY to survive (or thrive, if you’re better at retaining facts than I am) being pimped on the floor and in the OR.  Sometimes I would read the chapter that pertained to a certain operation, minutes before entering the OR, and get questions right because of it.  Its Q&A style makes it a faster read than the other books.  Its utility as a shelf study aid, however, is debatable.  This is the one I didn’t get all the way through; didn’t have time to read the “subspecialty” chapters.
  • I also bought Blueprints for Surgery (a review textbook sort of like First Aid; people don’t think it’s as good for surgery) and PreTest for Surgery (a book of cases/questions), but I didn’t get to either of them.
  • As I stated above, I also used the UWorld QBank.  We were told to get a year subscription to Step 2 CK because it would help in all the clerkships too.  Definitely do this.

I won’t know how well my efforts paid off on the shelf/the rotation for a while; I have no clue when we get evaluations back or how long it takes for all those shelf exam Scantrons to be processed and graded.  Trying not to think about it too much, but you can consider this a disclaimer to take my advice with a grain of salt–or a shaker of salt, as a college roommate and I used to joke.

This concludes my recap of surgery.  Next I’ll be on a 2-week elective before officially starting pediatrics.  I should have a bit more time to study and to live like a normal person, so we’ll see what comes of things.  I’ll keep you all posted!

Post-Surgery Rotation Update: Weeks 6-8

I spent my last 3 weeks of surgery on 2 different transplant services.  The first week I was on the renal transplant service.  I didn’t get to see a kidney transplant, but I saw a number of fascinating operations (even got to close incisions on a few, with some improvement from my time at the VA) and interacted with a few patients that have stayed on my mind since then.  In one of our courses, we discuss at length the importance of continuity of care; we were even encouraged to make a “panel” on the electronic medical record of patients whom we’ve seen or interacted with so that we can follow their course of care throughout the hospital.  There’s one patient, a little girl, whom I met on the renal service and want to follow for a while.

My last two weeks were on the hepatobiliary service, also known as the “liver transplant” service.  I spent a little time doing non-medical “scut” work such as pulling out drains and lines, a little time helping with elective cases in the OR, and  some time shadowing residents and attendings in clinic, but the meat of this rotation is the liver transplants.  They can happen at pretty much any time, mid-day or mid-night, and involve two main parts: 1) procurement/recovery of the liver and sometimes other organs from a donor who has been declared brain-dead, and 2) replacement of the recipient’s liver with the donor’s liver, which occurs soon after the first part.  The process can take a REALLY long time–especially if the donor is not already in the area, in which case the team might fly there.  I was involved in four transplants over 2 weeks–2 of which were back-to-back.  Thankfully there were other students on the service with me, so one person wasn’t expected to do both legs of each transplant–although one leg is pretty exhausting as it is!

For the first procurement I went on, we flew in a private jet to get a liver in North Carolina; I also got to ride in the back of an ambulance on our way to and from the hospital.  The donor operation itself was very bloody and very fast-paced; the surgeons are trying to free the organs they need as quickly and efficiently as possible, but they also have to take care to preserve the connecting vessels so that they may be used in the recipient.  This gets tricky if there are multiple teams trying to procure multiple organs, because sometimes 2 teams have to negotiate for sufficient lengths of the same vessels; for example, a heart surgeon needs the inferior vena cava, but if the liver is being procured as well, that surgeon also needs enough of the IVC to reconnect it in the recipient.

The second procurement I went on occurred at Vanderbilt.  Our team procured the liver and kidneys from the donor, while a different surgeon flew in to procure the lungs.  While helping the visiting surgeon, I got to hold the aorta while blood was still pulsing through it, and I later got to cut pieces of the spleen for Donor Services.  Since both the chest and abdomen were open for this case, I was able to see more anatomy than I remember having learned in class my first year.  The case was long, and the attendings pimped me to the point of exhaustion (mine, not theirs), but it was definitely worth it.

The two recipient operations I scrubbed in for were also fast-paced due to concerns with time under anesthesia and the time that the donor organ spends outside of a human body, but to me they felt a bit less frantic than the procurements.  The staff played music in the OR and frequently commented about how exciting it was that another transplant was happening, especially during the 1500th liver transplant.  Being part of this experience was so rewarding; seeing the liver darken in color as blood began to flow through it again at the end of the case made me smile.

All in all, my three weeks on transplant were some of the most tiring in my life.  There were plenty of nights when I woke up in bed, hoping I hadn’t missed an important text, plenty of early mornings after too little sleep and too much activity the day before.  After all of this, I’m still pretty sure that I’m not going to be a surgeon.  But I have loads of respect for anyone who goes that route.

Post-Surgery Rotation Update: Weeks 3-5

After my first 2 weeks on plastic surgery, I started on general surgery at the VA.  The service was a bit slower than some others that people were assigned to, which I didn’t mind–more time to study.  I did sort of mind having to navigate the VA’s EMR (and the accompanying paper charts) and having to subsist without wifi there, but I learned to manage, although I kind of felt like I was living in the 60s every time I came to work.

This service overall was a positive experience.  When my two classmates and I weren’t changing wound dressings on the floor, seeing patients in clinic, or hanging out in the call room, we saw a few colon resections, some gallbladder removals, and a ton of hernia repairs.  I started learning how to suture (according to a particular scrub nurse, I was pretty bad at it) and even got to drive the camera on some of the laparoscopic cases.

The second weekend that I was at the VA, Radial Grooves (the a cappella group) performed at Vandy Med’s Second Look Weekend for the prospective class of 2018.  I got to meet a few of the students before and after the performance; still don’t know if they’re coming yet, but they seem pretty cool, so I sure hope so!

Between the VA service and my last 3 weeks on surgery, I celebrated my 23rd birthday!  My parents and brother were in Nashville for part of the weekend, so I got to spend time with them as well as with my grandparents and aunts who live about 20 minutes away from me.  I also went to a pool party for Chapman College (Google “Vandy med advisory colleges” if you don’t remember me describing them last year) and ate wayyyy too much at the taco bar.  I had to stay up and work on a ton of assignments that night, but at least I got to see the light of day for a while.

Post-Surgery Rotation Update: Weeks 1-2

I spent my first 2 weeks in surgery rotation in a subspecialty.  I was placed in plastic surgery, and I honestly loved it.  I didn’t have much responsibility compared to the other services I was on, but I did get to help out with a number of cool operations.  For example, I saw a girl’s nasal septum repaired with cartilage from her rib, and I helped reconstruct the front of a guy’s skull after it was fractured in multiple places after an ATV accident.  In the latter case, there was a point when I was staring at the patient’s brain; the surgeons had removed part of the frontal bone of the skull, leaving his brain exposed, red and pulsing with blood vessels.  I’d seen a brain in a cadaver in the anatomy lab, but I never thought I would see one in its natural state…in a live human.  The brain actually looks quite a bit like its usual depiction in cartoons, unlike other organs.

The Saturday between my 2 weeks on subspecialty and my 3 weeks on my first general surgery rotation, the med school had Cadaver Ball.  This year, it was held in a different venue–Marathon Music Works in downtown Nashville, which is a lot different from Gaylord Opryland where it’s been held in the past–which worked out really well.  The catered food was amazing (I’m still dreaming about those sweet potato grits), and the entertainment was fabulous (a group of us danced onstage while both the 3rd and 4th year bands were playing…until we were escorted off, that is…).  Can’t wait to do that again next year.

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.