MS3, suddenly interested in procedural work.

[WaitWhuuut]

tl;dr I am becoming more interested in procedural and hospital work. What recommendations do you have for me?

Hello,

I'm a third year medical student; I never expected to be interested in procedural medicine. With that in mind I set a schedule that gave me exposure to the more analytic and longitudinal clerkships first. I'm completing my year in the required "procedural" clerkships, OB/Gyn and Surgery.

Right off the bat, I found that outpatient care and adult medicine- the "bread and butter" stuff I always thought I'd like to do- is less appealing. With that in mind, the first thing that caught my eye was psychiatry, but I realize looking back that it was fun more because of the patients than the field itself (I love talking to crazy people). Now that I'm back working with my hands and interpreting data, I'm having a lot more fun.

Lately, I'm finding that long hours, complicated caseloads, and procedural interventions are more and more interesting to me. I've done a few procedures-- I did family medicine in a rural site and had the opportunity to assist on several C-sections and one laproscopic procedure. Also, longer days at the hospital are more interesting and create a satisfaction that I wasn't expecting.

I scheduled my 4th year at the point where it was beginning to dawn on me that the hospital was where I belonged and I think I hedged my bet a little. So I am now trying to decide if I should amend my schedule and if I should, when is the right time to start making amendments.

Here are some thoughts and questions I have.

1. Does this initial plan make sense? Email the chairs and/or student liasons in surgical departments at my university post haste. Talk to them about expectations for the rotation and what sort of adjustments I should make to my schedule.
2. In a way, I'm kind of pulled to hospital medicine because of its analytic process as well. Are there "more cerebral" procedural specialties in the same way there are "more procedural" analytic subspecialties? A few folks have pointed out that I'd also do well in one of the specialties that does aggressive medical interventions-- I haven't ruled that out, either.
3. Does my story sound like a story for someone who is a good candidate to pursue surgical work?
4. Does the fact that I am almost 31 y.o. (no spouse, no kids) make it less practical? I really doubt I could handle 4 weeks of 100+ hours of work in a row, but I haven't attempted to go at it that hard since I was about 20 and taking an insane college course load.
5. One of my favorite parts of clerkships thus far is being a part of a team and working in the teaching/learning setting. It lights a fire under me. How difficult is it to find a program that establishes good collaborative environment in surgical training?
6. I have extensive experience in teaching and I love it. What is the trajectory for an academic surgeon?
7. Is there some question or concept that I should be considering that I am not?

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[filter07]

One thing I emphasize to all surgically inclined medical students it that they might have a bias towards procedural fields early in their training. After spending 2 years holed up in the library, it's not surprising to find surgery a refreshing change of pace. Also, procedures have a high "wow factor" for people who have never experienced blood and guts. Once you get more exposure, some of that wow factor might diminish. Just something to keep in mind.

I think most procedural specialties are also cerebral. It's just a different type of thinking. Instead of thinking about differentials, you're thinking about the best intervention, the best exposure, best postop care. Now granted a lot of that becomes routine as well, but surgical care can be fairly nuanced. Check out this article for more insight on this idea. It involves a PhD in political philosophy becoming a motorcycle mechanic:

http://www.nytimes.com/2009/05/24/magazine/24labor-t.html?_r=1&em

And it frequently requires complex thinking. In fixing motorcycles you come up with several imagined trains of cause and effect for manifest symptoms, and you judge their likelihood before tearing anything down. This imagining relies on a mental library that you develop. An internal combustion engine can work in any number of ways, and different manufacturers have tried different approaches. Each has its own proclivities for failure.

...Put differently, mechanical work has required me to cultivate different intellectual habits.

 

[WaitWhuuut]

Also, procedures have a high "wow factor" for people who have never experienced blood and guts. Once you get more exposure, some of that wow factor might diminish. Just something to keep in mind.

I am not impervious to the wow factor-- is anyone? For me, I think the biggest "wow" is in medical imaging, but I think I would miss seeing patients and caring for them. My mind is open to a lot of possibilities.

But lately, I've had the epiphany that: I prefer the hospital to the outpatient clinic, that longer days are growing on me, and I did enjoy the OR.

Thanks for your help.

I think most procedural specialties are also cerebral

I'm sure that is the case and I think I was being a bit too cavalier. I've never met a surgeon who couldn't keep up his or her end of the conversation, though I've met a few who couldn't be bothered.

 

[Winged Scapula]

Here are some thoughts and questions I have.

1. Does this initial plan make sense? Email the chairs and/or student liasons in surgical departments at my university post haste. Talk to them about expectations for the rotation and what sort of adjustments I should make to my schedule.

1. 
   
   Perhaps you didn't mean it to come off that way, but "talk to them about expectations for the rotation" sounds like you're telling then about *your* expectations.
   
   At any rate, I'm not sure what your goal is - is your 4th year full of outpatient clinic based rotations and you think you need more hospital based stuff?
   
   

   [*]In a way, I'm kind of pulled to hospital medicine because of its analytic process as well. Are there "more cerebral" procedural specialties in the same way there are "more procedural" analytic subspecialties? A few folks have pointed out that I'd also do well in one of the specialties that does aggressive medical interventions-- I haven't ruled that out, either.

   
   Don't kid yourself- it may seem like there isn't any analysis on your prior rotations but it happens in all specialties. Hospital based specialities are no more analytical overall than the outpatient ones, IMHO.
   
   

   [*]Does my story sound like a story for someone who is a good candidate to pursue surgical work?

   
   
   
   I don't need a fancy story - just someone who finds the work interesting and who works hard.
   
   

   [*]Does the fact that I am almost 31 y.o. (no spouse, no kids) make it less practical?

   
   Well, considering that makes you about a year or two older than *some* of the interns, and younger than others, I hardly doubt it makes any difference at all. Its not like you're 50.
   
   

   I really doubt I could handle 4 weeks of 100+ hours of work in a row, but I haven't attempted to go at it that hard since I was about 20 and taking an insane college course load.

   
   Where did you get the idea that it was 4 weeks? Residency is 48-49 weeks long.
   
   Look, some programs will be over hours and some rotations will be over hours. It will not be, in general, > 100 hours/week at all times. Some weeks might be.
   
   And you might be suprised to see that the hours go by fast especially if you're busy and you enjoy yourself.

 

[WaitWhuuut]

Perhaps you didn't mean it to come off that way, but "talk to them about expectations for the rotation" sounds like you're telling then about *your* expectations.

I meant quite the opposite. My expectations are to be confused, work, and learn. From my personal perspective, I feel like I don't start hitting reasonable rates of returns on my clinical work until well into a rotation. That's fine-- I figure this is probably about par in medical school and I tend to have a pretty sigmoidal learning curve in general.

But when I enter a new clerkship, I feel like I'm not up to "MS3" speed for a few days. I didn't really see it until I started my IM rotation in January (FWIW, I started my third year in the autumn, so this was only my 3rd rotation and my first one where I was on the same team as a classmate). So my new thinking is that I need to put in a few hours in advance of my clerkships to mentally prep for the new service and hit the ground running with studying to catch up.

At any rate, I'm not sure what your goal is - is your 4th year full of outpatient clinic based rotations and you think you need more hospital based stuff?

Yup, hospital stuff and procedural stuff. And I'm sure these same folks I want to ask about the above issues would have coursework recommendations.

Don't kid yourself- it may seem like there isn't any analysis on your prior rotations but it happens in all specialties. Hospital based specialities are no more analytical overall than the outpatient ones, IMHO.

You're correct, of course. Analytic is the wrong term in retrospect as I cannot imagine calling any aspect of medical care "non-analytic".

I was trying to get to this point. Different services have different daily schedules. Internal Medicine's stands out as particularly geared towards critiquing colleagues' decision-making and making sure "fascinating cases" were discussed by the whole department in morning report. From what I've heard of the surgical service in the same hospital, it's hard to imagine anything like a morning report or rounds that go on for hours. Which isn't even to say that surgery doesn't have its own unique analytical components, it clearly does.