Should I be concerned?

[grandinsurg]

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I'm starting surgery residency in 1 month and have just realized something:

My last surgery rotation was 9 months ago. It was the last time I tied anything, sutured anything, did anything related to surgery. I spent the last several months on medicine-y rotations as per medical school requirements. I don't even know if I remember how to tie. It's been that long.

Should I try to brush up on skills in the next few weeks? Find suture material? Practice on a pig's foot? Read anything? So far, my only plans are to buy house, move to new state (where residency is), unpack, and fix the house.

 

[LovelyRita]

I'm starting surgery residency in 1 month and have just realized something:

My last surgery rotation was 9 months ago. It was the last time I tied anything, sutured anything, did anything related to surgery. I spent the last several months on medicine-y rotations as per medical school requirements. I don't even know if I remember how to tie. It's been that long.

Should I try to brush up on skills in the next few weeks? Find suture material? Practice on a pig's foot? Read anything? So far, my only plans are to buy house, move to new state (where residency is), unpack, and fix the house.

If you're going to be a surgeon, it will never hurt or be a waste of time to practice ties. Invest in some good pens too, because as an intern you'll be writing a lot of orders. And if you're not writing them you'll be typing them so sharpen your typing skilz.

 

[SLUser11]

I'm starting surgery residency in 1 month and have just realized something:

My last surgery rotation was 9 months ago. It was the last time I tied anything, sutured anything, did anything related to surgery. I spent the last several months on medicine-y rotations as per medical school requirements. I don't even know if I remember how to tie. It's been that long.

Should I try to brush up on skills in the next few weeks? Find suture material? Practice on a pig's foot? Read anything? So far, my only plans are to buy house, move to new state (where residency is), unpack, and fix the house.

It's pretty rare for a new surgical intern to not know basic surgical techniques like knot tying and suturing. I think it's very important that you brush up on your technique.

Rumors and judgments occur fast in residency, even if it's completely unfair. You do not want to be labeled as the "weak intern."


In hindsight, and in addressing the current MSIIIs, you should probably continue to practice these things even if you're not on a surgical rotation.....that is, if you're interested in a career in surgery.

 

[JackADeli]

...Should I try to brush up on skills in the next few weeks? Find suture material? Practice on a pig's foot? Read anything? So far, my only plans are to buy house, move to new state (where residency is), unpack, and fix the house.

Do not stress. Take a weekend or two with a pig foot, talk with some surgery residents about helping you practice and review a little bit of the surgery re-call. But, do not stress. You will have five years or more to learn to be a surgeon. Your skin closures will suck including the stapled ones until you get over your jitters. Every attending will have a different way they want it..... and everyone knows that's just the way it is.

JAD

 

[Pir8DeacDoc]

People will be far more likely to label you the "weak intern" if you're lazy and don't take care of business. If you knew how to operate you wouldn't need residency (plus, you probably won't see much of the OR as an intern anyway). Brush up on some knowledge if you want but the important parts of starting residency and being a good doctor in general are being:
1. affable
2. available


3. able

If you have one and two then people will work with you to develop the third one.

Enjoy the last bits of freedom and moving to your new city.

 

[Buckeye(OH)]

What if your new city is a serious downgrade :-(

 

[SouthernSurgeon]

I'm starting surgery residency in 1 month and have just realized something:

My last surgery rotation was 9 months ago. It was the last time I tied anything, sutured anything, did anything related to surgery. I spent the last several months on medicine-y rotations as per medical school requirements. I don't even know if I remember how to tie. It's been that long.

Should I try to brush up on skills in the next few weeks? Find suture material? Practice on a pig's foot? Read anything? So far, my only plans are to buy house, move to new state (where residency is), unpack, and fix the house.

This is why I'm taking EM really late in my fourth year...I plan on begging and pleading with my residents to sew up every laceration that comes through the door...plus I can potentially go to the OR during my off days.

 

[SLUser11]

People will be far more likely to label you the "weak intern" if you're lazy and don't take care of business. If you knew how to operate you wouldn't need residency (plus, you probably won't see much of the OR as an intern anyway). Brush up on some knowledge if you want but the important parts of starting residency and being a good doctor in general are being:
1. affable
2. available


3. able

If you have one and two then people will work with you to develop the third one.

Enjoy the last bits of freedom and moving to your new city.

There's a big difference between "knowing how to operate" and knowing how to tie a simple knot. Pure and simple, the OP should practice prior to the start of residency.

Still, I usually give contrasting advice to the MS4s. I tell them to allow the MS3s to scrub cases preferentially, since they do have 5 years to learn how to operate. I tell them to instead focus on perioperative care, etc. After all, some interns are great at CVLs immediately while others have never placed one. By the end of the year, most of them are equally proficient.

However, I give that last paragraph of advice under the assumption that they are capable of simple surgical techniques that they learned during their third year. If an intern can't tie a knot, but all the med students on rotation can, I guarantee that intern will be labeled as weak.

 

[surgres88]

and being a good doctor in general are being:
1. affable
2. available
3. able

If you have one and two then people will work with you to develop the third one.

Where did these "3" items come from? A book, a speech? I'm just curious because when I was a med student a fellow classmate used this same line on me and billed it as their own deep reflection. This is now the third time I have heard it used...Now, I'm not buying my classmate originated this.

 

[Winged Scapula]

Where did these "3" items come from? A book, a speech? I'm just curious because when I was a med student a fellow classmate used this same line on me and billed it as their own deep reflection. This is now the third time I have heard it used...Now, I'm not buying my classmate originated this.

This used to be quoted to me all the time as well, so I suspect your colleague is stretching the truth about being the origin of the phrase.

 

[PostCall]

would it be fair to say that a new surgical intern should already know how to do at least the following technical procedures before even starting internsip?

draw blood
take an ABG
put in IV
put in NGT
put in foley
basic instrument tie
two-handed and one-handed tie
subcuticular stitch

 

[JackADeli]

would it be fair to say that a new surgical intern should already know how to do at least the following technical procedures before even starting internsip?

draw blood
take an ABG
put in IV
put in NGT
put in foley
basic instrument tie
two-handed and one-handed tie
subcuticular stitch

Draw blood: I never drew blood in medical school. But, in most, the antecube was easily visible so you just stuck it if anyone actually asked. I guess the draw blood "know how" would be to learn in trauma room how to hit femoral vein.
ABG: yes, learn this
Place IV: not really. it is another task I never did except one afternoon session with other students. I still don't put in peripheral IVs. If a nurse that does them 6-12 times a day can't get it... I am not likely to given I am asked once every couple of years. The patient gets a central line PRN.
NGTube: yes
Foley: yes
basic instrument tie: yes
two hand tie: yes
one hand tie: no
SQ stitch: you should have a reasonable grasp of the concepts and be able to struggle through a ratty closure. Then, with increased and more consistent experience you will be quite proficient.

just my opinions

JAD

 

[PostCall]

one hand tie: no

any particular reason? why not learn it along with the two hand tie? once when i was scrubbed in the intern two hand tied and the attending was all "you're tying like a med student, you're a doctor now!" implying he should be one handing it but he didn't know how so the attending told him he could tie next time after he went home and practiced and didn't let him tie for the rest of the case.

 

[Fah-Q]

All surgical interns are pretty useless in the OR except as an agile retractor. I doubt anyone will notice if you are slightly worse than terrible.

Don't sweat it. You'll be fine. Nobody is going to ask you to sew the aorta next year.

 

[Pir8DeacDoc]

All surgical interns are pretty useless in the OR except as an agile retractor. I doubt anyone will notice if you are slightly worse than terrible.

Don't sweat it. You'll be fine. Nobody is going to ask you to sew the aorta next year.

Pretty much the point I was trying to make as well.



I don't disagree that learning to tie knots is important, but it will come with practice and the OP should brush up on these things once residency starts. Likely he won't see the OR anyway and why spend the last bits of freedom and normal life stressing about perfecting ties??

 

[Pir8DeacDoc]

That saying I gave above is from one of my attendings. He trained at Duke so maybe it originated with Sabiston??


No way in hell your friend came up with that and he shouldn't even try and take credit for it.

 

[Sarcoidosis]

To all your residents and attendings, how are prelim surgery residents treated in comparison to the categorical ones at your program... are there more or less expectations with regard to their surgical abilities... are they given less preference with regard to being trained?

 

[JackADeli]

any particular reason? why not learn it along with the two hand tie? once when i was scrubbed in the intern two hand tied and the attending was all "you're tying like a med student, you're a doctor now!" implying he should be one handing it but he didn't know how so the attending told him he could tie next time after he went home and practiced and didn't let him tie for the rest of the case.

My experience has been that most attendings want you to focus on two hand ties. You need to be proficient at throwing a perfectly square knot. One hand ties often look flashier and quicker.... but in reality, most one-hand throws I have seen at all levels (i.e. intern to attending) have NOT been square. There really is more finesse and finer skill involved in a good one-hand knot and most never actually pay attention.... because in all knots, most never really have an overt consequence. The knot cinches and the tissue is closed over it.... no one pays attention or ever sees the granny know again.... except on occasional emergent re-explore.

I have seen a "med-student" two hand as compared to a good resident two-hand.... it was night & day. You can get good and fast at throwing good two hand knots. That should be you first focus in that regard. A proficiently thrown and perfectly secure square knot.

To all your residents and attendings, how are prelim surgery residents treated in comparison to the categorical ones at your program... are there more or less expectations with regard to their surgical abilities... are they given less preference with regard to being trained?

Some places view all PGY1s as equal and it doesn't matter if categorical or prelim because your ultimate status really is determined at the end of the year! That is when the PD informs the prelim they would like to keep him/her and th categorical that they really should consider ED. Other programs will use prelims as pure fillers and warm bodies. There is a highly reputed program in Boston that highers prelims that it will never, never make categorical. As in all things surgical residency.... it depends on the program. You need to consider the record of your individual program as to hwo they treat prelims in past years and what is the turn-over of PGY1&2s....

JAD

 

[Sarcoidosis]

There is a highly reputed program in Boston that highers prelims that it will never, never make categorical. As in all things surgical residency.... it depends on the program. You need to consider the record of your individual program as to hwo they treat prelims in past years and what is the turn-over of PGY1&2s....
JAD

The program I am at is very large, reputable?, good university program, however they have more prelims than cat for gen surg. I haven't had the chance to inquire and have not tried to inquire about the outcome of their prelims from them yet, as I don't want to seem....
Because I got the position during the scramble. I rather focus right now on just enjoying a chance to do surgery for a year, but as a prelim... it seems I will be judged all the time.

 

[JackADeli]

The program I am at is very large, reputable?, good university program, however they have more prelims than cat for gen surg. I haven't had the chance to inquire and have not tried to inquire about the outcome of their prelims from them yet, as I don't want to seem....
Because I got the position during the scramble. I rather focus right now on just enjoying a chance to do surgery for a year, but as a prelim... it seems I will be judged all the time.

Yes, you will. As an intern/first year, you will be judged all the time no matter categorical or prelim. The extent will be program dependent. Thus, if concerned, you will get an idea from your program and not likely from bulletin board/forum. Just focus on doing the best job you can and NOT what "prejudice" you may see... cause you can not change that.

 

[Anka]

Don't sweat it. You'll be fine. Nobody is going to ask you to sew the aorta next year.

That too is program (and intern) dependent. Some programs put a lot of emphasis on technical skill, even at a junior level. If you fail to hit your benchmarks, it is held against you. If you go beyond your level, you're a "strong intern" or "strong junior", assuming nothing else is concerning. The people who are technically better, and therefore aren't expected to slow down the case, get called to the OR more often. You'd hope it's something you'd pick up on while interviewing.

Other (probably most, given what I've heard) programs are more egalitarian.

Anka