MY SITES and THOUGHTS
Thoracic Surgery: I was with a small team of an attending, senior resident and intern for three weeks. My experience was strictly thoracic and did not have any cardiac surgeries. Most surgeries were thoracoscopic wedge biopsies, segmentectomies and lobectomies with some esophageal procedures. There were some robotic surgeries and an emergency thoracotomy. There were a few bedside chest tube placements as well. I really enjoyed my experience in thoracic surgery. The cases can be repetitive, but every case is different, which was really surprising to me. In addition, I really enjoyed the post-op care, which was complicated and challenging. In one word, I would describe my experience here as complex.
Orthopedic Surgery Sports Medicine: I was with an attending who did shoulders and knees. The surgeries were quick same day in and out arthroscopies, and ACL and rotator cuff repairs. ACL repair was my favorite, because it was fairly involved compared to the other procedures and was super satisfying to see the final result. Of course the drills and hammers were fun. There was no inpatient experience, so hours were pretty good. I had a lot of clinic time, which were a lot of fun. The patient population is fairly healthy and super eager to get back to their exercise and outdoorsy activities. In one word, I would describe my experience here as fun.
ENT Otology and Consult: I surprisingly really enjoyed my experience in ENT. The clinics were one of my favorite. They see wide variety of cases that include a lot of congenital defects, which is fascinating. I saw patients with different genetic syndromes including Angelman's and Trisomy 13 that I never expected to see. They see patients of all ages which is something that I haven't seen anywhere else. The surgeries were very intricate, involving heavy use of microscopes. They could be boring to watch, but it is probably very interesting when you are the person who is doing it. In one word, I would describe my experience here as diverse.
Surgical Recall has a description of an ideal medical student on surgery service. I would say it is little exaggerated but pretty close to reality. The most important one for me was to eat and drink whenever you see food or water. I got something to eat whenever I had 5 minutes and access to any type of food. There were some days I overate, because the day ended up being pretty chill. But there were days I did not see a sight of food until 4-5PM. So I always had cliff bars in my pocket.
I was told by many people to not talk unless I am spoken to. I would say avoid small talks or trying to be one of them unless it comes naturally with time. Don't be their shadow. I think it is uncomfortable for everyone when you just tag along everywhere when it is unnecessary. If they are doing notes, I was close enough to know if they were leaving, but far enough that they don't feel like they have a shadow. It does not mean you should be lost and clueless all day though. Definitely ask what the plan is for the day for you if schedules change daily or you are new to the service.
Always ask if you can scrub in or try to close up or put in IV etc. It is really nerve racking to ask those things especially if you have never done it before. But most people would love that you are interested in learning and trying. Nobody expects you to know all those things anyway. Also if you are unsure of anything at all, you should ask someone. It is always better to ask than to do something you were not supposed to do in the OR. I usually ask nurses. They always have answers and usually are more than happy to help you.
On the same notes, I always went to the OR and introduced myself to the nurses. Let the scrub tech or nurse know you are scrubbing in and bring your gloves and gowns. As soon as you introduce yourself to circulating nurses, ask if they prefer you to write your name somewhere. If you do that the first thing in the morning, you will have much better experience the rest of the day in the OR. The OR staff will make or break your life in the OR for sure.
One of my good friends is a surgical resident. When I asked if she had any tips for me, she told me not to be one of those med students who always want to leave early. We were expected to be on service 6AM to 6PM. There were a few days I stayed well over 6PM, but there were a few days I was released around 4:30PM. I removed the thought of leaving early from my brain for good, because leaving an hour and half earlier was not going to make a difference whether or not I get other things done at home. So if it does not make a difference, why bother with it.
Never speak to an attending without having looked at images before hand. Even if you are in rush or late, always try to read images yourself and form your own opinion before reading radiology impressions. They don't expect us to know how to read images. So just telling them if there was any gross masses or anatomical problems and if there was any changes compared to the old images is usually enough, then go on to the official radiology read. It is the effort that counts and they will be more apt to teach you once they look at the images themselves. I was terrified of looking at any images until I was forced into it. I am still not good at it, but I learn a little every time.
Make sure everything that comes out of your mouth regards to patients is true. If you are not sure, then just say you are not sure. For example, if you said K level is 5.2, then it better be 5.2, not 5. If you are not sure, "I believe it was somewhere around 5, but I will look it up." is much better answer. It sounds crazy, but I think it is a good habit to get into regardless of what specialty you are on, because you want to be reliable no matter what you are doing.
During clinics, I always asked myself what I want to establish in a room before I knock on the door to see a patient. It reminds me to form my own assessment and plan. Then I usually started my presentation with two sentence assessment and plan. I got more meaningful feedback regards to differential diagnosis and treatment plans afterwards. If you just start with your presentation, they most likely will not let you finish your presentation anyway. I think it is a good way to let your preceptors know where your knowledge is, so they can taylor their teaching to your knowledge gaps. I don't think this is going to fly well in inpatient internal medicine though.
I did not have Internal Medicine clerkship before surgery. So my opinions on study resources reflect my knowledge at that time. People who had Internal medicine prior to surgery might have different opinions. Most people who had internal medicine before surgery told me Pestana's surgery and Uworld should be enough. However, I can't vouch for reliability of that information.
- NMS Casebook:
I loved the setup of this book. It walks you through diagnosis, management and treatment of different clinical cases in question and answer format. The book does not read smoothly like a book. But when I used the online version (comes with the book) on my phone, you can actually see the question first and then click to see the answers. It is almost like doing questions. The content is similar to Pestana's surgery. I think the format of this book requires you to think more actively compared to Pestana's Surgery. You must know the content of this book for the shelf, so if it works for you then, it is worth a shot.
- Pestana's Surgery:
I was told that it is the same book as Kaplan's Surgery Review with questions at the end. This version fits in the white coat pocket, so they are great on the go. The content is similar to NMS casebook, but in a paragraph form. Because it is so condensed, you might not retain everything the first time. So going through it a couple times might be worth it. The questions at the end are nothing like shelf questions. However, they are really useful to detect your specific knowledge gap though.
- Kaplan Q Bank and Uworld:
I used both earlier in the rotation, so I forgot most of it towards the end. I recommend doing them later in the clerkship. In general Kaplan is detailed oriented vs. Uworld that is more concept orientated. I would not pick one over the other. They are both great sources of questions. I redid the questions I got wrong a week before the test to refresh my memory, which was really helpful.
- Essentials of General Surgery:
I am a textbook reader. But I honestly couldn't get through a chapter of this book. There are too much that are not shelf relevant. If they had a high yield condensed version, that would have been a great resource. If you can get through this book in 10 weeks, please let everyone know how it was in the comments.
- Surgical Recall:
I read a few chapters. It has all the pimp questions. So it is a good refresher before surgeries. This is not a study resource for the shelf.
- Step Up to Medicine:
I was pretty prepared for the surgical part of the shelf. But I was not prepared for the medicine aspect of the shelf. I did not have time to study for medicine anyway. So take medicine before surgery OR If you have the time and stamina, I would recommend you to get through this once in addition to studying surgery books.
- Lange Q&A:
It was recommended by residents to me. I did not use it, but I wish I did. I think this book might have given me some idea on random medicine questions on shelf. I heard it is not the greatest book, but there is't anything else available. So beggars can't be choosers.
BE SURE TO STUDY
- Everything about GI. Pay special attention to diagnosis, management and treatment of pancreatitis
- Emergency medicine - trauma management in general
- Subdural vs. epidural vs. subarachnoid hemorrhage
- Pediatric orthopedics
- Congenital heart defects
- Venous insufficiency vs. diabetic peripheral neuropathy vs. peripheral vascular disease
- Internal medicine heart, lung and kidneys if you have time.