Notes for a medical student interested in surgery

March 27, 2021rawatenatorUncategorized

Notes for an MS1-2-3 interested in surgery

My advice: print this out and check things off as you do them. Also, these are rough notes I mostly type on my phone, so they’re not going to be pretty/tgramatical/typos will exist.

  • Stress management/Mindset vids. Success in 3rd year I think is actually largely based on staying energetic, entheusiastic, happy. this makes the grind enjoyable at best, and endurable at worst. Hence, I’m talking about this first.
    • Getting therapy isn’t a sign of weakness, it’s prophylaxis.
      • It’s recognition that this is a tough journey. to be at your best, many ppl myself included, can benefit from someone to help us develop skills to thrive during this time. More ppl get it than you’d expect. A lot more need it.
      • I avoided it for a while and thought it would be embarrassing, but then I found out that some of my friends who I looked up to in surg went through tough mental health times bc of the stress and that made me more open to the idea. Eventually I went and have no regrets.
      • Now I think: are you better off avoiding therapy and getting to 85% of your potential clinically an 50% of your potential socially/emotionally/as a person — or, getting therapy 1d/week, and getting help as a “person” to be at 75% of your potential socially/emotionally and 90% of your potential clinically. In fewer words, this is a tiny investment of time and money which helps you to grow as a person and ultimately helps you do better in school/clinic. Most ppl figure this out when they’re burning out or about to burn out.
    • Good Ted Talks
    • Common sourses of stress/resources to get better info/advice
      • (how) will I get into residency?
        • need mentorship. start with student affairs/deans who are friendly/surgical mentors/or if none of the above, listen to a podcast called “short white coats” for good advice. Then go back and try to find mentors again.
      • I suck at this
        • causes: perfectionism, expecting to be perfect, being too hard on yourself
        • causes: maybe not trying enough or not having enough energy to try harder, exhaustion, burnout
        • tx: therapy, talk to senior students about their rotation experiences, ask senior students/interns about which study resoruces to use, get help to create better time managment skills (maybe someone at student affairs responsible for academic coaching/tutoring who can help with this), mentorship, growth mindset (tedtalk above, also book by Dweck)
          • if at USC, good course called “preparing to teach/lead in residency” by dr Julie Nyquist) for mindset stuff
      • Debt levels
        • White Coat Investor (so that you are more empowered about the debt you’ve picked up. MUST read/listen, also see his blog)
      • Even if you’re not ‘concerned” about debt, you prob should be.
        • You should read that book if you have >$5000 in debt.
      • Not learning enough about social determinants of health in school
        • in MS3/4 not so much time is spent on the social side IMO. Here are some good things about these thigns:
          • Invisible women (also on audible) – amazing chapter about treatment of women in medicine
          • Medcins Sans Frontiers (Doctors without borders) podcast. So great!
          • Hood Feminism (also on audible) – per a friend, “pop feminism doesn’t always deal with gun violence, food scarcity, homelessness that affects lots of poor ppl. this is a book about issues that are important in lower income communities”. Haven’t read yet but is in my Audible.
          • Improvised medicine – my fav med book to flip through. how to build makeshift equipment to provide care in the developing world. cool for ppl intersted in global health, wilderness med, emergency med, or medical innovation
      • Other good stuff you prob have already seen:
        • gomerblog
        • dr glaumflaucken on twitter
  • exercising + staying fit during 3rd year
    • idk about you but when I’m not fit, my mental health goes downhill pretty fast
    • when you’re wearing scrubs it’s easy not to notice you’re putting on weight
      • A lot of ppl like to whine about being req’d to dress up for clinic, but I think wearing normal human clothes is a much under-appreciated way to notice if your belt size is going up 😐
      • when you’re in the hospital a lot, you don’t get a lot of exercise. running around the hospital does not compare to a real workout. nevertheless there is some stuff you can do:
        • take the stairs whenever possible, WHENEVER POSSIBLE, WHENEVER POSSIBLE.
        • Say NO to tater tots, waffles, fries, pancakes unless you have the metabolism of a 15yo M. Occasionally, I run into a senior resident who eats like this and somehow still manages to have a 6 pack. Idk how they do this, but maybe it has to do with them having a tiny bit more flexibility in their schedule to do an AM run or hit the gym.
          • on the other hand, I’ve seen several ppl who were fit in med school but slowly gained weight from M4 onwards with each year of residency. avoid the taters, and eat the oatmeal. As one of my seniors going into colorectal said, fiber’s good for your colon and most americans don’t get enough.
        • Guerrilla exercise:
        • during your off minutes, do 5/10/15 (your choice) squats and lunges. maybe in a changing room if you don’t want to draw a lot of attention to yourself lol.
        • if you get to go outside e.g. for lunch, do 5-10 pushups (i think pushups on hosp floors are gross)
        • if the surgery break room has a pullup bar do 3-4 pullups every time you can
      • keep a heavy weight / sandbag at home for daily squats/bench/shoulder presses (alternate the exercise daily)
      • try to walk/jog/run as soon as you get home
        • if it’s too late, stairs in your building while listening to podcasts/phone-calling are good too
        • stairs/hills turn walking into resistance training 🙂
        • (next place I move to, I am looking for someplace near a hill to make this easier to do)
      • one of my wrists is pretty tight, so every AM I need to take 10m to do wrist stretches. light stretching in the morning can be good to calm down and prep for the day ahead.
    • Sports passions
      • I know that I can keep getting better at judo even though my schedule is tough
      • in M3/M4 I cant/couldnt train on the mat as often
      • But have had enough time to stay conditioned/even improve my baseline strength somewhat
      • In residency, I plan to work with my sensei’s (teachers/coaches) to create specific practice plans so that I build on my skills and make full use of the few days I can actually train.
        • I expect my progress to be slower, but incrementally better, an I hope to get to at least 1-2x competitions next year.

# Gensurg specific

  • good podcasts
    • general/how to pick a specialty: short white coats
    • surgery: behind the knife (interviews with experts in different surgical fields, technical)
    • surgery: legends of surgery (more narrative, interesting stories)
  • Succeeding on clerkships
    • MUST DO!!!!! read this post on being a good medical student.  VERY HIGH YIELD.
    • do lots of qbank questions
    • somehow don’t burn out +friends +mentors +role models ahead +eyeontheprize +resident mentors/friends +improvement +therapy +learn about burnout +learn about inequities in healthcare +create change when possible (leadership helps bc too much to do alone)
    • if you’re not going to honor, feel free to ask a lot of questions and try to learn learn
    • what’s more important: looking smart or making improvements and learning? for mental health: learning, confidence
  • Good Qbanks:
    • Uworld, Amboss
  • Finding mentors (see below)
    • shadowing
    • don’t give up any opp. to talk to a surgeon or surgical resident
    • ask about favorite operations, most challenging cases, what are their research/scientific interests, controversies in their field of surgery,
    • other questions: what are important problems that are under-studied, under-appreciated,
    • other questions: how can you do these procedures in lower income settings / developing world settings
    • listen to behind the knife in your free time/exercise time to get some baseline understanding
    • do rotations earlier
    • Getting involved in research
      • know some time constraints
  • books
    • ONLY if you have time. First priority read uptodate and learn the anatomy for your current cases, read the correspondign chapter of DiVirgilio, and surg recall. Also do as much Uworld on off days as you can. It helps to have Uworld on your phone. Lots of times throughout the day when you have an extra 5 min. Do a question or 2 during these times and your study load will be a lot better. Make sure you study something every night (1h+ goal), no matter how tired out you are, force 30m minimum. It’s a matter of principle. Even if you’re falling sleep fight through it. This is the only way to build the habit.
    • Recently, found it helpful to have a study buddy for accountability, ideally someone who is on the same rot and wants to do surg as well. Set reading/study goals with each other and enforce them. if someone doesn’t do the reading, they buy the other person lunch etc.
    • divirgilio – one of my mentors read this book completely through surgery and a second time throughout the year. I wasn’t able to read nearly as much. But will try to finish it sometime during what’s left of MS4.
    • Surgical recall
  • subis
    • do a subI in each geographical region you’re going to apply to (* so I’ve heard, during COVID all my subIs were at my home institution)
    • do after step 2
    • try to do best for step 2
      • confidence you get from this is huge
      • best strategy do UWorld 2x if possible, otherwise 1x + wrongs x1
      • if still rushed, do a research year, and study during it
        • just make sure you’re productive
  • LOR/ also some good questions to develop a good learning relationship with a mentor
    • try to talk to mentors during rot about how they choose surgery
    • how they chose program to go to
    • who were their good mentors in med school, residency, beyond
    • how do they advise getting mentorship throughout residency
    • kinds of extracurricular research/projects/activities they did while in residency (to give you some ideas about what you could do too)
    • how do they stay connected with academic surgery
    • How can you get involved in some projects to get a feel for clinical resaerch
    • Can you help with a case report so that you can learn how to do one?
    • Could we schedule some time to talk about my progress on the rotation and get advice for next steps in career (near end of each rotation)
  • Shoes
    • your feet will get tired.
    • I tried Danskos, Calzuros and they worked for a while, but ultimately the best solution for me was:
      • sitting more throughout the day (obviosly not during the case). find ways to sit more and stand less during the off times (but still take the stairs for the inc venous return 🙂
      • wearing COMPRESSION SOCKS!!!! LIFE SAVER!!!!!!!!!!! I say buy a set of 7 on amazon and use them daily!!!! Learned this in 4th year but would have made yr 3 so much better.

# Neurosurgery

My first surgical rotation was in NSG. I learned so much about what is expected of a student on surgery and got some great advice from the interns/residents. For anyone interested in neurosurgery – here are some notes based on what I’ve heard/experienced during rotation

    • one of the coolest subis I did. I really liked the residents I worked with. super hard working, passionate, but some were def burning out bc of the daily challenges of dealign with illnesses that can be really devastating and having a tremendous amount of responsibility for so many patients.
      • (This is also the first rotation when I realized that there are so many ways to streamline hospitals to make this specialty (and all surgical specialties) more efficient and better. Shame on Cerner and hospital IT for not doing better 🙁 , but the blame is also on all of us for not advocating for better workflows)
    • the sooner you know this is a specialty you like, the better
    • Good ppl to follow on instagram: Martin Pham (cool/inspiring/informative)
    • strong mentor relationship and connections required to match
    • Several NSG student organizations exist. you are expected to join and participate in their events
      • MSNTC?
    • Most ppl I know take a research year to develop/show/prove (your pick) their commitment
      • if you make your decision in 3rd year, plan to do a research year
    • commitment and passion and connections “might” make up for not perfect scores…because, this is a demanding specialty with high rates of burnout for ppl who are not truly passionate.
    • Greenberg’s NSG book – req’d, carry it in your “pocket” (lol, the latest edition it’s way too big to fit, but carry it around with you anyway)
    • before rotation
      • ideally take a neuro-rads rotation to:
        • understand vessels to brain
        • learn how to differentiate T1 vs T2 vs DWI vs GRE MRIs
        • learn how to generally recognize anatomy on CT angios
      • ideally take neuro
        • bc neuro can be cool
        • read chapters in adams and victor that interest you.
          • one of the BEST neuro books i’ve ever read. wish i had enough time to read cover-to-cover
      • review neuro notes from MS1-MS2
      • review how to deal with electrolytes and TBI
        • sodium, hypo, hyper natremia

# Skills:

  • Knot tying
    • still trying to figure this out. Got some feedback about crossing/uncrossing my hands that I’m still trying to figure out.
    • I think a lot of surgeons end up learnign some thigns on their own
      • watch videos, practice on pig feet/other meat, then show up to a case and offer to do a task. when someone likes your performance, they’ll let you do more. THis is an example of how a little bit of work upfront can get you much more experience. this is direct advice given to me by other residents.
      • Additionally, residents frequently go to the anatomy lab (with permission) to practice operations on their own on cadavers. This helps them build confidence and learn the anatomy without the pressures of the OR. Then when it’s go time, they’re confident and will prob get to participate more.
  • Different kinds of suturing
    • mattresses
    • interrupted
  • different kidns of suture materials
    • 2,4,6 MVP

# looking towards intern year (TBD)

  • when/how to schedule meeting times with mentors during intern year given the weekly work requirements
    • do ppl ever meet with weekends on weekend off days?
      • TBD

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