confidence in surgery

[lakersbaby]

hi guys,
for those of you doing your residency in ENT or already an attending when did you gain confidence that you would be able to do surgery? As a first year med student I feel as though I would love surgery but am unsure of my ability to be a good surgeon. I know not anyone can be a surgeon but can you still gain all the skills necessary to become a great surgeon through residency or is there still something else that you are just born with?

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[resxn]

Good question.

I will say this for sure--some people just "get" tissue. I say that as an attending because there are techs with whom I work and some of them just understand how to hold tissue and some of them even after trying to teach them for several cases still don't know how.

When I was a student I had the hardest time "seeing" planes. A doc would say, "Can you see the platysma there?" And for the life of me it just looked like fat with the blood and all mixed together. I couldn't tell jack.

Sometime in my internship early-on the lights just went on and I got it. Surgery came pretty easy to me after that. I was always considered the guy with good hands, not necessarily the smartest one. I wanted it the other way around until I became a senior resident when I sort of caught up to the genius residents through tons of study but was still considered an asset on complex cases by the attendings.

Besides patting myself on the back, my point is, if you don't feel you're good at surgery, you can become good. You can become excellent. Some start out ahead of others but the race can change a bunch.

There were some residents who never got it, though. I saw some who just were never good surgeons and just didn't understand the basic rule of surgery in my opinion: Basically you can screw around and cut and remove whatever you want except for nerves and lumens (vessels and aerodigestive). If you learn how to stay away from nerves and lumens, you can pretty much do whatever you want.

In it's basest element, that's a neck dissection. Remove everything with cancer or possible cancer and spare all the lumens and nerves.

There's a few exceptions, like when taking out a thyroid and looking for the parathyroids, but overall,that rule keeps you safe 99% of the time.

 

[TheThroat]

With practice, anyone can become a good surgeon. But with anything, there is always a degree of innate skill that is involved.