choosing a surgical residency

[DocnHoc]

Hi all; I am currently a 3rd year medical student who is highly considering doing a surgery residency. I find appealing the chance to work with my hands as well as the seemingly definitive solutions that are characteristic of surgical (as opposed to medical) treatments. However, one concern that I do have is that upper level classmates have commented to me that surgeons don't "use their heads" as much as other doctors; that surgery is more or less performing a trained task repetitively. While there may be some truth to that, what surgical specialties offer the most challenge, as far as planning new approaches on procedures, or coming up with novel treatments for conditions, etc. ? Thanks

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[Brewster]

Since you are posting on a surgery forum, you will get a resounding "NO" to your first question. I tend to agree. Surgeons do use their heads. There is a lot that goes into preop workup and well as postop care. In addition, you have to plan the appropriate procedure, plan the appropriate approach, and then do it, all the while making intraop decisions that could drastically affect outcome. This does not mean that every case is going to be a brain-teaser, but then again, how many pediatricians have to spend a lot of time thinking about how to treat that URI?

Different specialties have different perks. I will say that fields such as urology and ENT offer a mix of nonoperative/clinic work as well as operative stuff (sort of a mix of medicine and surgery). Neurosurgeons deal with the CNS (obviously) and many would say that big advances in neuroscience are around the corner. In addition, neurosurgeons deal with nonoperative (and operative) management of conditions such as intracranial hemorrhage and head/spinal cord trauma.

If you truly love operating, go into surgery (or a surgical subspecialty). Ask yourself if you could go through life not being in the OR. When you were doing nonoperative clerkships (especially medicine and peds), did you find that you were engaged in what you were doing or did you wish you could be the one taking that pancreatits patient for pancreatic debriedment?

Hope this helps.

 

[hotbovie]

HMMMM,,

If surgeons are so dumb, why are most of the highly competitive residencies surgical ones? And if medicine doc have such superior intelligence, why is it that medicine is one of the easier matches?

Hopefully, you are far enough along in your 3rd year to realize that the comments, though typical, arent true. Correct that some of the basic procedures, once learned, are pretty routine (but then so is treating HTN!!).

Surgery requires a lot of thought. First, you must decide when to operate, and sometimes more importantly, when NOT to. Surgeons manage a patient's medical problems when a patient is on their service. Complications can arise, which must be dealt with. Surgeons must manage pts in the ICU.

I think one of the most rewarding things will be the fact that, as a surgeon, you can do things that NO ONE ELSE can do! Can't get a line in??? Call surgery! Drop a lung putting a line in...call surgery!
Perforate the colon during colonoscopy...call surgery!! Can't find or stop a GI bleed....call surgery!!

Every specialty has it's own intellectual strenghts and weaknesses. Ask your surgery residents how many times they have been called for "abdominal pain" and it turns out to be a bogus consult. Each specialty has its own fund of knowledge, but that of surgery general isn't taught in med school (cuz school is run by PhD and medicine docs)

There's something for everybody in surgery...more meticulous types go for ENT, plastics or vascular. Adrenaline junkies go for trauma. People that like neruo go for neurosurgery. Want to operate and have a great lifestyle? Optho's for you. Like immunology...perhaps transplant is your thing (BTW, most decent immunology research is done by transplant surgeons). Like oncology...surg onc.

Take some time, hang out in the OR, go pop in on various cases, meet and talk to the residents in the various subspecialties. Get an idea of what each is like from those in the trenches.

Do what you love, don't worry about what your classmates think. You'll ultimately wind up bailing them out of messes, I guarentee.

 

[Castro Viejo]

Originally posted by hotbovie
If surgeons are so dumb, why are most of the highly competitive residencies surgical ones? And if medicine doc have such superior intelligence, why is it that medicine is one of the easier matches?

Well, that's more likely because of the relative number of positions offered in Internal Medicine versus the spots offered in General Surgery.

Overall I agree with hotbovie. There's a lot more thinking that goes into surgery and being a surgeon that a lot of medical students and non-surgeons, for one reason or another, seem to miss.

The reason why I applied to general surgery is because of the potential within surgery to still be creative in both practice and research. There's a lot for which the surgeon of the future will be responsible, and many of the most important discoveries in medicine will be, and have been, made by surgeons.

A surgeon refines his (or her) approach for each patient. Just as no two patients are identical, no two surgeries will be exactly the same.

Don't let your friends decide for you whether or not surgery is intellectual, find out for yourself!

Good luck.

 

[afmsboy]

Originally posted by hotbovie
HMMMM,,

Can't find or stop a GI bleed....call surgery!!

Except for massive GI bleeding from varices or esophageal rupture, most GI bleeds stop on their own. As for calling Gen Surg for occult GI bleeds I have never seen that done. What will Gen Surg do here? An Ex Lap to make a longitudinal incision across the length of small bowel to identify this bleeder? This is a sincere question. Any Gen Surg out there please educate me.

 

[droliver]

I get occult GIB consults all the time, its not that rare a consult. In stable patients they usually get upper & lower endoscopy (+/- anoscopy if hemmorhoids are palpated) looking for the usual suspects. Recurrent bleeding without obvious sources may require angiography, tagged RBC scans, or meckel scan's for localization. Now longitudinal incisions along the SB would be very rare (except in the duodenum if you suspect an ulcer), but subtotal colectomy for unlocalized LGIB is the treatment of choice sometimes

 

[afmsboy]

Originally posted by droliver
I get occult GIB consults all the time, its not that rare a consult. In stable patients they usually get upper & lower endoscopy (+/- anoscopy if hemmorhoids are palpated) looking for the usual suspects. Recurrent bleeding without obvious sources may require angiography, tagged RBC scans, or meckel scan's for localization. Now longitudinal incisions along the SB would be very rare (except in the duodenum if you suspect an ulcer), but subtotal colectomy for unlocalized LGIB is the treatment of choice sometimes

Thanks for your reply.

My understanding of the work-up for occult GI bleed is as you have outlined. In my hitherto limited experience I have seen GI services along with Rads handle the work-up. As for fixing such bleeders, I know our esteemed surgical colleagues are always happy to oblige with definitive therapy.

 

[hotbovie]

I've seen two pts with major GI bleeds go to surgery in my short experience with surgery, the first on my first week...pt was admitted to the ICU by medicine for profuse GI bleed, they couldn't catch up (I don't recall if GI got involved). At any rate, pt underwent ex-lap and was found to have an ulcer that perforated and eroded the gastroduoedenal artery...can't fix that with an endoscope!!

Second pt was just last month, acutally I was in the MICU. Pt was admitted with GI bleed, scoped from above and below, no source ID. Then had tagged red cell study which showed LUQ bleed, later locaized to proximal jejunum on arteriography. IR couldn't embolize due to constriction of vessels, so he went to OR. It must have been a very cool case (I talked to the resident later). They did multiple enterotomies (small holes in the bowel) and GI came, scrubbed and with a sterile scope scoped the entire small bowel. No bleeding found, pt did well, HCT stabilized, and on POD 4 we wrote transfer orders to the floor (pt stayed on medcine service the entire time, followed closely and primarly managed by surgery..acutally transplant as he is a kidney recipient). As he was about to go to floor, he got on the bedside commode, dropped his pressure and became apneic, after passing about half the bucket worth of blood!!! So I paged the surgery resident, and off we go again to the IR suite, now bleeding again in the same place, but this time they were able to embolize. Surgery still had to follow, as a possible complication of the emboization is ischemia of that segment of bowel. OK, so surgery didnt' actually fix this pt, but they were very much involved in the care of the pt who was acutally much more complicated than I described and it was surgery who provided all his ICU care, despite the fact that the MICU team was primary (MICU team also made some errors in his managment,and basically wound up just staying out of surgery's way). He required lots of knowlege and finesse to manage, and I learned more from this patient than from almost any pt I have had so far, on any rotation, though most of my education came from staying after my MICU hours were over and discussusing his case at length with the surgery resident.

Anyway, hopefully you can tell from my posts that I absolutely love the field of surgery. I promise it offers plenty of intellectual challange, and I'm getting really sick of the dumb surgeon myth and plan to do all I can to dispell that myth. I hope Brewster likes surgery as much as I do. If not , I hope s/he can find a field that s/he likes as much as I like surgery. Life is so much better when you love your job!!

 

[afmsboy]

Originally posted by hotbovie

Anyway, hopefully you can tell from my posts that I absolutely love the field of surgery. I promise it offers plenty of intellectual challange, and I'm getting really sick of the dumb surgeon myth and plan to do all I can to dispell that myth. I hope Brewster likes surgery as much as I do. If not , I hope s/he can find a field that s/he likes as much as I like surgery. Life is so much better when you love your job!!

First off, I give due props to everyone that loves what they do and do what they love. Also massive props to all the hardworking surgeons and trainees out there. A life of sacrifice and dedication is worthy of respect.

However, I always shudder at the practice of denigrating another field/profession/occupation in the vain attempt of magnifying one's. The field of medicine is vast and special in that it allows people of varying interests to identify niches where they are useful to themselves and society. I have this Quixotic dream of a day when Internists, Surgeons, Psychiatrists, EM docs and OB/Gyns (grudgingly ) will coexist in mutual respect and adoration.

Dude, you dont have to dispel any myths, anyone with sense knows that it takes more than knowing how to wield a scalpel to be a competent surgeon and that for a surgeon to be good, he/she has sound cognitive and technical skills. No point trying to convince anyone who doesn't know this otherwise.

 

[Jay Shoaps]

I might point out that currently one of the most gifted and eloquent medical writers is Atul Gawande (Complications: a surgeon's notes on an imperfect science), a senior GS resident at one of the Harvard hospitals, and a staff writer at the New Yorker. (enough to make anyone feel truly unproductive.)

 

[vuillaume]

The heart of this thread is silly. All medical specialties demand certain skill sets. All of medicine sets relatively high-intellectual hurdles for getting into medical school, graduating from medical school, finishing a training program, and passing Boards. I'm going to be a surgeon, but I thank my stars that I have classmates who choose to do Medicine, Med/Peds, Radiology, Dermatology, &c. It'd be a sanguinary day if surgeons were the only doctors in the hospital--all those onc, CHF, diabetes and ESRD patients would be dying like flies.

Human disease is too complex for one approach. Sometimes a medical approach to a problem is the most relevant, sometimes an interventional approach is best.

Different people have different styles--no discipline is vastly superior to others.

Also, as someone else has pointed out, the only reason it's easier to get an Internal Medicine slot is that most major medical centers that need something like 40 medicine interns, only need about 10 surgery interns. It merely has to do with bodies.

I think parochialism when it comes to specialties is really counter-productive.

The key to deciding whether you want to be a surgeon or not, is deciding whether you're only happy if you get to go to the OR. If the thought of never being able to scrub again makes you sad, this is suggestive that a surgical career is in your future.

Being a *good* doc is intellectually demanding whatever specialty you choose.

 

[afmsboy]

Originally posted by vuillaume
The heart of this thread is silly. All medical specialties demand certain skill sets. All of medicine sets relatively high-intellectual hurdles for getting into medical school, graduating from medical school, finishing a training program, and passing Boards. I'm going to be a surgeon, but I thank my stars that I have classmates who choose to do Medicine, Med/Peds, Radiology, Dermatology, &c. It'd be a sanguinary day if surgeons were the only doctors in the hospital--all those onc, CHF, diabetes and ESRD patients would be dying like flies.

Human disease is too complex for one approach. Sometimes a medical approach to a problem is the most relevant, sometimes an interventional approach is best.

I think parochialism when it comes to specialties is really counter-productive.


Being a *good* doc is intellectually demanding whatever specialty you choose.

Well said and kudos to you.

 

[OwlMyste]

Originally posted by Brewster
Since you are posting on a surgery forum, you will get a resounding "NO" to your first question. I tend to agree. Surgeons do use their heads. There is a lot that goes into preop workup and well as postop care. In addition, you have to plan the appropriate procedure, plan the appropriate approach, and then do it, all the while making intraop decisions that could drastically affect outcome. This does not mean that every case is going to be a brain-teaser, but then again, how many pediatricians have to spend a lot of time thinking about how to treat that URI?

Different specialties have different perks. I will say that fields such as urology and ENT offer a mix of nonoperative/clinic work as well as operative stuff (sort of a mix of medicine and surgery). Neurosurgeons deal with the CNS (obviously) and many would say that big advances in neuroscience are around the corner. In addition, neurosurgeons deal with nonoperative (and operative) management of conditions such as intracranial hemorrhage and head/spinal cord trauma.

If you truly love operating, go into surgery (or a surgical subspecialty). Ask yourself if you could go through life not being in the OR. When you were doing nonoperative clerkships (especially medicine and peds), did you find that you were engaged in what you were doing or did you wish you could be the one taking that pancreatits patient for pancreatic debriedment?

Hope this helps.

This is my opinion--but I think that other residencies tend to bash the surgical residencies/surgery in general because they are somewht jealous...I mean, who else would get to use a scalpel, open up someone, fix whats wrong with them, etc..except for a surgeon? not that everyones jealous...just those that badmouth surgery and say that surgery residencies make you dumb, etc...

 

[The Pill Counter]

this thread's about choosing a surgical residency. how about spending your time choosing a college first owl? the joke's wearing thin, owl, or should I say troll? I hope for your sake, you are a troll, otherwise, it would be really sad. has anything that several people have commented on about your inappropriate posts sunk in yet?

 

[OwlMyste]

Originally posted by The Pill Counter
this thread's about choosing a surgical residency. how about spending your time choosing a college first owl? the joke's wearing thin, owl, or should I say troll? I hope for your sake, you are a troll, otherwise, it would be really sad. has anything that several people have commented on about your inappropriate posts sunk in yet?

I have chosen a college already...some ppl actually like my posts...they say keep up the good work...so obviously my posts arent as innappropriate as you would have hoped...im beginning to think that if I even posted in the undergrad forums, that I would still be made fun of/mocked/teased by some of the people in this forum...read my quote..its what I live by...don't like it?...tough!

oh..and about the troll thing....must you result to name calling?

shows your maturity level.....or in this case...lack thereof...

my college i have chosen and gotten accepted to is www.gdn.edu (gordon college)..FYI...

 

[neilc]

hey jessica, the only reason people could have for asking you to keep posting, as you claim, is to enjoy the oftentimes hilarious jokes made at your expense.

seriously, give it a rest...move along, or at least stop asking ridiculous questions and getting involved in topics that you have zero understanding of. what would possibly cause you to think you have something worthwhile to contribute to a thread titled "choosing a surgical residency"?

with your annoying banter, i am doubting you would ever get past interview phase for med school, so you may want to go to the pre-med forum and ask something like "how do i hide my personality defects from adcoms?"

hugs and kisses

 

[Celiac Plexus]

Originally posted by neilc
so you may want to go to the pre-med forum and ask something like "how do i hide my personality defects from adcoms?"

hugs and kisses

This, coming from a guy who had to go to the Czech Republic for med school.

Take it easy on the kid. He/she is just as entitled to post as you, or anyone else is. If you don't like Owl's posts, then just ignore them. Relax.

 

[neurogeek]

This isn't meant to start an argument, but not every American at a foreign school "had" to go there. Some pick a foreign school over very good US schools. Celiac, I know you didn't say that that is the case every time, but I've seen that attitude around on the forums a little, so I just wanted to comment.

 

[neilc]

Whatever CP...funny, that when i comment, i get the "he's just an IMG" crap from you...there are plenty, plenty of people who are simply tired of trying to ignore Owl's comments, which are usually pretty worthless. but, i guess they went to an american med school, which makes it cool.

i have been happy to live and let live, to ignore and to let others do the bashing. but, frankly, it is very annoying, and i am tired of looking in on an interesting thread, and then reading some comment from Owl trying to get involved.

so, owl, maybe some freindly advice. i was a bit hostile before, but i am annoyed with you, as many others appear to be. some questions to ask before you post:
1. will this question be helpful to me in the near future? asking about lifestyle and such is ridiculous at your point, just do a search and see what has been said if you are interested.
2. do i have anything positive to contribute to this thread by responding?
granted, not every thread is meant to be serious or helpful, but i think these might be helpful guidlines for you. your earlier spamming did not make many freinds, so maybe slow down a bit.

 

[ortho1]

i agree w/ all of you who have tried to post to this girl that her ?'s are out of place. I have very little time to surf the net and have read this site for about a year but did not post b/c i didn't feel i had anything to contribute. now that my AI apps are due and 3rd yr is winding down i feel that i can contribute more, or at least use this site to my advantage when applying for res. i cannot tell you how annoying it is that in the little time i have to read these posts i have to sift through all this bs to get to the meat of things. We all know there is something amiss about this girl so let's just leave it alone already.
To jessica: here is a little advice...take it or leave it but don't respond b/c i have spent enough time on this as is....you have heard of the phrase "putting the cart before the horse". What you need to be doing instead of spending time here is talking to your high school counselor. You have gotten into college which is great. Now, make sure you are taking the proper courses, go talk to the college counselor. Since i have never heard of Gordon college i'm assuming its not ivy league (don't get huffy, this is a fact). i would concentrate on getting the first 2 yrs. done w/ exceptional grades then think about transfering to a school more challenging or with a bigger presence. The better the school, the better your grades, the better your numbers, the better chance to get into med school. Your third yr you'll take the mcat. Instead of spending time posting here, start studying for that or take a pre-med course through your school to help prep you in something like bio or chem. Lastly, you better realize that these people your posting to will (if you don't change your mind in the next 10 yrs) be your superiors. The medical community is not as big as you may think. The road to becoming a doctor is long and requires planning and organization. Your steps now should include reading a basic book on getting through college and pre-med courses. There are plenty out there, and don't ask me for one...go find it yourself. This is something you will hear a lot of in college and med school so get used to it now. I hope you will understand that i have a few hours to myself every week, spending this much time on someone else is a sacrifice. Take the advice of all these people and take a step back. If you spend all this time here, it means your not spending it studying and studying is the only way your going to reach your goal. Take it from someone who does nothing but read, this is your time to enjoy being young and free of responsibility. The one thing you do not want to do is regret not enjoying it when you had the chance.