3rd year rotations to do before surgery?

[theonlytycrane]

Is IM and OB recommended before surgery?

I think I might lead off with IM, but I was hoping to ask for any input? I'm also reading through the other threads (sorry in advance as I know this is a repeated question!)

thanks

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[DrGoon]

I put a lot of thought into the order of my rotations last year. In retrospect, I don't think it mattered.

 

[theonlytycrane]

I put a lot of thought into the order of my rotations last year. In retrospect, I don't think it mattered.

May I ask what your order was?

 

[DrGoon]

psych, general surgery, family med, IM, research elective, neurosurgery elective, pediatrics, obgyn, psych elective

 

[Donald Juan]

Like said above, it won't ultimately make any big difference. From the standpoint of the shelf exam it would be slightly beneficial to have IM and OB prior as they may help with some questions.

 

[NotaCop]

A typical and often used schedule for one interested in surgery is as follows

Peds - get your feet wet in a low stress environment
OB - early OR exposure
IM - crucial to have right before surgery to maximize your success on the surg shelf
Surg - crush it
Psych - relax after surg takes your soul
Family - finish on a generalist specialty to ease into Step 2 CK study


This assumes that your school uses these 6 clerkship of course. Adapt to whatever your specific program offers. Most important would be to have IM and surg back to back in that order to maximize your chances of crushing the shelf

 

[WedgeDawg]

I think it’s beneficial to have medicine prior to surgery from a medical knowledge standpoint and OBGYN from a comfort in the OR standpoint. I would also try to do surgery in the first 2/3 of the year when you still have more energy. However it won’t make *that* much of a difference so if it doesn’t work out or you don’t have a choice, don’t worry too much.

 

[operaman]

Agree that it doesn’t really matter much in the end. It’s funny how I remember thinking there were many medicine questions on the surgery shelf but as I look at sample questions now they seem so drastically different. There may be some small advantage to doing one or the other first but I think it’s small and the overlap not nearly as much as you’d hope.

For me, I did surgery first rotation of third year followed by IM. I had a strong step one score and felt I had a strong enough foundation to build on quickly for the surgery shelf. This is where I think it may make a difference for some; if you feel like you’re a bit weak on fundamentals, you might benefit from a little time to adjust to shelf/CK style questions.

My other thought behind doing surgery first (follows by IM and 2 field specific electives) was to be sure early on that I wanted to go this route. I came into school confident in my field choice but I knew people often changed during third year. If that was going to be me, I wanted to know in September rather than April.

I do think OB offers some OR experience but at least in my n of 1 it wasn’t that much nor was it terribly interesting. This probably varies significantly by school so worth asking your upperclassmen.

Another plus to doing the big guns first is the rest of the year feels like a cakewalk and you have a very strong foundation for all future shelves.

 

[ParallelLines]

My other thought behind doing surgery first (follows by IM and 2 field specific electives) was to be sure early on that I wanted to go this route. I came into school confident in my field choice but I knew people often changed during third year. If that was going to be me, I wanted to know in September rather than April.

How much of a gauge do you think your surgery rotation gives you on what the subspecialties are like? Asked another way, do you think it's possible to hate your surgery rotation yet still be a "fit" for certain subspecialties (ortho, uro, plastics, etc)?

 

[operaman]

How much of a gauge do you think your surgery rotation gives you on what the subspecialties are like? Asked another way, do you think it's possible to hate your surgery rotation yet still be a "fit" for certain subspecialties (ortho, uro, plastics, etc)?

Hmmmm excellent question. I think it could go either way depending on what exactly you hate about your surgery rotation. If it’s the people on your assigned service or the type of operations you’re doing, then you might still find your fit in another gen surg field or one of the subspecialties.

If you find that you just don’t like being in the OR, or that the hours and unpredictability are unsustainable, then it may be worth some soul searching. Basically, if the thing you hate is universal to any surgical field, then that’s time to seriously consider a different path. If it’s simply a dislike of an element unique to your singular rotation, then maybe you’d still be happy elsewhere in a surgical field.

Obviously in the OR you will do a lot of retracting and holding hook and that’s ok. It’s funny how students feel so uninvolved and that retraction isn’t that important. Now as a senior resident I find myself getting annoyed by attendings who are retracting for me because it feels like are doing the whole case with the retractor! So don’t knock retraction too much and don’t listen to other students who knock it either. Just because you aren’t good at it yet doesn’t mean it isn’t a critically important part of the operation.

Sorry for the tangent but it’s a common thing I hear students complain about. Just something to keep in mind as you’re feeling out the OR and trying to decide if you like being there or not.

General surgery does give a pretty good sense of most subs but it probably won’t feel that way as a student. The general thought process, basic surgical techniques and skills, the graduated responsibility in training - all those are similar. The culture can vary substantially between the fields as can some of the specific surgical techniques (ie endovascular, micro, endoscopic, laparoscopic, etc) that are used. The balance of clinic/inpatient/outpatient/emergent work will vary quite a bit too.

 

[theonlytycrane]

@operaman thanks for the helpful post above^

You mentioned having an idea of what field you wanted to go into early on -> did you end up going into that field?

 

[operaman]

@operaman thanks for the helpful post above^

You mentioned having an idea of what field you wanted to go into early on -> did you end up going into that field?

I did! Ended up having great experiences in 3rd year and really felt at home in the surgical world. I figured there was a slim chance of changing my mind but still wanted to get that figured out early.

I will say that even to this day I find the OR to be mind numbingly boring IF I haven’t prepared for the case and it’s something I’ve never seen before. Watching someone else operate when I have no clue what’s going really sucks, so I would highly recommend anyone thinking about surgery really put in the effort to prepare. Retracting is less boring when you know the steps and the anatomy and understand exactly what you’re showing the person who is dissecting. It will also be immediately clear to the surgeons that you are prepared and they will be much more likely to let you do more as a result.

 

[afib123]

I did! Ended up having great experiences in 3rd year and really felt at home in the surgical world. I figured there was a slim chance of changing my mind but still wanted to get that figured out early.

I will say that even to this day I find the OR to be mind numbingly boring IF I haven’t prepared for the case and it’s something I’ve never seen before. Watching someone else operate when I have no clue what’s going really sucks, so I would highly recommend anyone thinking about surgery really put in the effort to prepare. Retracting is less boring when you know the steps and the anatomy and understand exactly what you’re showing the person who is dissecting. It will also be immediately clear to the surgeons that you are prepared and they will be much more likely to let you do more as a result.

How do you prep for these cases (not sure if you are in general surgery or subspecialty) ? Is there a textbook that you refer to? I rotated in a surgical subspeciality for an elective and could not find most of the procedures online or on youtube. I later realized I needed to get the books for that speciality to look up the procedures, but wondering how you do your prep.

 

[operaman]

How do you prep for these cases (not sure if you are in general surgery or subspecialty) ? Is there a textbook that you refer to? I rotated in a surgical subspeciality for an elective and could not find most of the procedures online or on youtube. I later realized I needed to get the books for that speciality to look up the procedures, but wondering how you do your prep.

I’m in a sub.

Let’s see in a nutshell:
1) read the patients chart. Understand their history, their disease, and why the heck you’re operating
2) review their scans. This is hard early on but you’ll get better with time and it’s nice to correlate with what you see in the OR. Ask a resident to help with this if you’re struggling to learn what to look for.
3) look on YouTube for a video of the procedure. Watch it.
4) review relevant anatomy. Then re watch the video above
5) find a specialty specific book or website that lays out steps of the operation. Review these. Watch video again.
6) talk to your senior resident or whoever is covering the case the day before. Do this after you’ve already prepared as above. As a resident- especially once you’re more senior - attendings will expect you to discuss cases with them well in advance so get used to that now.
7) review any other relevant reading. If it’s a cancer, understand the staging and general treatment paradigm. Understand the indications for doing what you’re doing.

I’ll stop here to add in my own pet peeve:

Look at the OR schedule ahead of time. I know all the cases on my service well in advance and have generally reviewed their charts and imaging the week prior. Yes even cases I’m not in. Now that’s a bit much for a student but it isn’t too much to expect you to see what’s coming and prepare for the cases you're going to be in. Ask your residents the week before to help you if you can’t find the case postings as some systems make this a pain to find. My biggest pet peeve is when students ask me after morning rounds “what should I do today?” I don’t know - whatever you’ve prepared for which is clearly nothing at all!

Sorry. Little rant there.

Basically you should be able to give a formal presentation on the patient you’re operating on. And you should know the steps and be familiar with the anatomy of what you’re about to do. Once you’re used to it the prep should take about an hour or so for a big case.

 

[afib123]

I’m in a sub.

Let’s see in a nutshell:
1) read the patients chart. Understand their history, their disease, and why the heck you’re operating
2) review their scans. This is hard early on but you’ll get better with time and it’s nice to correlate with what you see in the OR. Ask a resident to help with this if you’re struggling to learn what to look for.
3) look on YouTube for a video of the procedure. Watch it.
4) review relevant anatomy. Then re watch the video above
5) find a specialty specific book or website that lays out steps of the operation. Review these. Watch video again.
6) talk to your senior resident or whoever is covering the case the day before. Do this after you’ve already prepared as above. As a resident- especially once you’re more senior - attendings will expect you to discuss cases with them well in advance so get used to that now.
7) review any other relevant reading. If it’s a cancer, understand the staging and general treatment paradigm. Understand the indications for doing what you’re doing.

I’ll stop here to add in my own pet peeve:

Look at the OR schedule ahead of time. I know all the cases on my service well in advance and have generally reviewed their charts and imaging the week prior. Yes even cases I’m not in. Now that’s a bit much for a student but it isn’t too much to expect you to see what’s coming and prepare. Ask your residents the week before to help you if you can’t find the case postings as some systems make this a pain to find. My biggest pet peeve is when students ask me after morning rounds “what should I do today?” I don’t know - whatever you’ve prepared for which is clearly nothing at all!

Sorry. Little rant there.

Basically you should be able to give a formal presentation on the patient you’re operating on. And you should know the steps and be familiar with the anatomy of what you’re about to do. Once you’re used to it the prep should take about an hour or so for a big case.

Thanks!

 

[Styrene]

Is IM and OB recommended before surgery?

I think I might lead off with IM, but I was hoping to ask for any input? I'm also reading through the other threads (sorry in advance as I know this is a repeated question!)

thanks

Just from my own experience, thought having medicine, primary care, OB, and peds was made the surgery shelf much easier (especially barely having any time to actually study during surgery).