As a student during clerkships... what was the extent of what you we’re able to perform in OR?

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med2345

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Obviously my question is very program dependent but... what was the extent you were able to do during clerkships and how often? Basics (retraction, suctioning, suturing)

or something more involving? I&D, osteotomy cuts, drilling and or/screw fixation amps? Ect.

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So far just retracting, suctioning, cutting sutures. I got to throw some sutures and remove some screws too. Still have some programs to go but I think its very program dependent.
 
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Program dependent.

Did the basics at some.

Got to use saw, throw screws, do amps start to finish.

Depends on the program + how competent you are + how the residents view you + if there's time for you to do stuff
 
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I found it also depended if you were scrubbed in with a PGY-1, 2, or 3. The first years are more inclined to do it all themselves because they want the experience themselves vs the third years who have done it all already and are ok with sitting on the sidelines and letting the students do a bit more.
 
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I got to do probably 10 or so skin to skin procedures throughout my externships. This is not the norm though.
 
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Like others said, doing skin-to-skin cases as a student is not uncommon, but it takes the perfect storm of the right student, the right resident, and the right attending, at the right time, and on the right day. You're not a bad student if that perfect storm never comes together. Just do what is expected for students and do it well. Setup the OR, retract, suction, anticipate the instrument(s) that will be needed next and have it ready, ask appropriate questions at the right time, don't break sterile or contaminate the field, and be able to throw a half decent suture or hand tie if asked. I know for a fact that my performance doing an I&D, foreign body removal, and hammertoe "skin-to-skin", on the rare occasion it happened, was insignificant in getting me a residency position compared to doing the basic student stuff well.
 
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Experiences with this are going to be so variable.

I went to a program once where some guy had like 6 students scrub in to throw 2 sutures a piece on a toe amp. I bet that toe necrosed afterwards
 
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Yes, it is totally program dependent. It really all depends on their surgical volume and number of residents.

At some clerkships, you'll barely scrub in at all (since it's easier to see if you're not scrubbed in if 2-3+ residents are already scrubbed in).
At others, it will just be you and the resident, and you will get a fair amount of exp depending on the teaching/comfort of the attending and the resident.

It is a bit of a paradox since the "first year cases" like HWR, amps, I&D, digits, etc will generally let you do more due to only one resident there (if it's a quality program), but the more complex cases are more interesting to watch (yet you will be blocked by multiple residents/students to some degree).

Also, don't ever take it as a knock on you if the attending and/or resident fly through the case and don't let you be involved much. Sometimes they need to get back to office, have multiple cases to do afterward, the case started late, etc. You don't realize it when you're a student, but even if you have practiced your sutures, etc... you are still probably in the bottom 10 percentile among attendings and senior residents.

...Your best bet for getting the most of cases is to read about the the night before. It helps to ask the resident what fixation will be used, etc. You might get a basic question or two on the procedure or the setup (TAGS-X stuff), and the right/wrong answer could increase/decrease your involvement. I usually did that for students or a resident I wasn't familiar with :)
 
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Too many variables. It'll be totally program/case/attending dependent.
As a student I had an attending walk me through a TMA in June at a program that the residents already had their numbers.
I threw screws in a fibular plate once when a resident got paged to the ER during an ankle case.

Other days I leaned against the wall in a crowded OR with residents, reps, other externs, and 3rd year students on their clinical rotations. Pretending to watch when in reality I couldn't see a thing.

Just prep for every case as if you're doing it skin to skin solo. Eventually you'll get a chance. You won't know when it's coming, and you don't want to be unprepared.
 
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During my final year of training, I let students do as much as they felt comfortable. Feli nails it though - I do the same for new residents I'm not familiar with.
 
Besides the usual stuff of doing a lot of suturing retracting etc, I got to do a hammertoe skin to skin at two different programs, a TAL, and a second met resection. But it is very program dependent. At one program, me and my coextern were full close suturing like half of all the cases and that was also where I did the TAL and one of the hammertoes. Then after getting really good at suturing from all that practice that month, the next two months I only got to suture once each at both programs. Huge difference and I didn't realize how good I had it/how much of an outlier that first program was until much later.

Then the next program after that I did the other hammertoe but that was lucky (or maybe smart) on my part bc it was November and they gave us off for Thanksgiving and Black Friday but I volunteered to come in on Friday bc they were doing a Keller that day and I up to that point still hadn't seen one in person. So I met a non-core attending for the first time that day and I guess I made a good enough first impression that he let me do it. It also helped that the resident mentioned it was my last day, whenever some attendings hear it's your last day/week, they seem to flip a switch and be MUCH more likely to let you do stuff from my past experiences lmao. The 2nd met res was a last day case as well.

Also the best way to get to do a hammertoe is if its scheduled for multiple ie 2-4. The resident will knock out the first two and let you do the last one, that's how it happened both times for me. The TAL I got to do bc it was a b/l case so while the chief resident was teaching the 1st year on the right foot, the attending decided to teach me on the left foot/leg simultaneously. So like others said, it really has to be the stars aligning up with the right attending/right procedure/right situation/right time.
 
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