Surg Residency physically demanding?

[shockerMS1]

Hello,

I am an MS1 and interested in surgery residency-and new to this forum. Ive been told that surgery residency is "physically demanding" by current MS3's.

Whats a good way to prepare for these stresses- aside from working out every other day.

Also, I was thinking of that would ease the workload on the body: Do shorter people (5'6"-5'9") have less stress on their back when operating vs. taller people because they dont have to strain and bend over as much?

Thanks for your input.

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[DoctorDoom]

1. Sleep when you can.
2. Eat when you can. A balanced diet of 55%carbs, 30% proteins (fish and chicken), 15% fats. Lots of vegetables, fruit. Stay away from junk food.
3. Hydrate. 1 gallon of water a day.
4. Be in good physical shape before you get there.
5. Be nice, be thick skinned. Don't let mental stress over picayune issues break down your body.
6. Calisthenics based exercises. Workout during down times on call. A set of 50 pushups really clears the head and helps keep you awake at 5 AM.
7. Avoid caffeine and cigarettes. Trust me on this one.
8. Avoid refined sugar. No candy or soda.

The operating table can be adjusted. The attending or chief will adjust the table to their preference. You will have to adjust with step stools. So see #5 above and don't worry about it.

Focus on your first two years. Surgery will be waiting when you're done.

 

[hotbovie]

I did fine during my 3rd year surgery clerkship, as well as electives early in the 4th year without any special working out. And I'm much older (in my 40's). Not that I wasn't tired, but by the time I did the surgery rotation (did it later in the year), I was already used to staying up all night on call from other rotations, so that helped.

Surgery does tend to be more demanding, because you have to do all the things that other speciaties need to do for their patients, plus spend time in the OR. Sometimes it's fairly easy, sometimes it's pretty hard, especially when you are the student on a long case....you can wind up holding a retractor for hours and not see a thing. No one likes this part of surgery. But it changes when you are the one doing the operation. I am tall, and my back hurts most of the time, it's usually just a matter of degree. (usually less after a case when the resident is tall, too and has the table adjusted to a height that happens to be good for me too) Often I emerge from case with pain in back, knees, and feet...but also feeling very satisfied. (compare that to long internal medicine rounds, I get the same pains, plus emerge feeling bored and frustrated)

I wouldn't worry about it too much right now at your stage. Things have already changed a lot, now that the work hours for residents will be limited. Last year at my institution, we did q 2 call on trauma (that means every other day we'd be there from 7am to 7am...24 hours on, 24 hours off). I found it wasn't too bad for a few weeks (though the residents typically did 2 months of this and it wore on them). This kind of scheduling will no longer be allowed starting in July....and it is no longer being done where I am (kids today have it so easy...just kididng)

I wish I had worked out during first years of med school, I'm doing it now and I feel a lot better. Working out is a good stress reliever, as well as good for helping prevent creeping weight gain. But do it for those reasons, (obviously not soley to prep for surgery clerkship).

If, when you do the rotation, you enjoy it like you expect, you'll probably be willing to put up with the drawbacks. THere are parts of many rotations that leave you feeling physically drained, but when you find the field you like it enegizes you psychologically so that the physcial stuff seems less severe.

 

[womansurg]

Having just gotten home at 8pm, after operating all day, culminating in a four and a half hour hepatectomy performed with loupes and a head lamp - I can answer this with a resounding 'yes'.

I'm tired, man. Thank god I'm not on call tonight. Where's my pizza?

 

[southerndoc]

Originally posted by womansurg
Having just gotten home at 8pm, after operating all day, culminating in a four and a half hour hepatectomy performed with loupes and a head lamp - I can answer this with a resounding 'yes'.

You were in the OR all day? Cool! I wish I had a day like that.

Being in the OR for 16 hours in a day doesn't bother me.

It's rounding, seeing new patients in the ED, etc. without going to the OR for 16 hours in a day that bothers me.

I can be in the OR for 40 hours straight and still go home with a smile on my face. OK, so I'm psycho.

 

[DoctorDoom]

Careful what you wish for...

Wait until it's your 6th straight week of Q2 call, and your work week averages 130 hours, and you're the one holding the pager, not the intern above you.

Oh wait, I forgot, we don't do that anymore.

Forget what I posted, surgery residency is a cakewalk.

 

[tussy]

Yes, surgery is physically demanding. I'm a pgy2 general surgery resident. I'm also a 5'4", 120 lbs woman who does not go to a gym. I have the most well developed calf muscles from always having to stand on my tip toes to operate. I often get a stool to stand on, but sometimes the nurses forget to get it for me, other times the stool is tippy, so i can't use it, or if i need to use the foot pedal (eg. laparoscopic cautery, harmonic scalpel) you can't use a stool. Also, i have chronically sore shoulders from pulling retractors for hours on end.

Combine these muscle aches with the poor nutrition. I do 1 in 3 call, the hospital i work in has a cafeteria that only serves deep fried food and it clothes at 6pm - that means many days i eat a coffee and muffin for breakfast, hamberger and fries for lunch, and something from a vending machine for dinner.

Then there is the sleep deprivation. Working >100 hours/week and still trying to study in between because they keep telling me that i'm not reading enough.

I won't even mention the mental health aspects of all of this.

But then, you get operate which makes it all worthwhile! Surgery is fun!

 

[womansurg]

Originally posted by tussy
I have the most well developed calf muscles from always having to stand on my tip toes to operate. I often get a stool to stand on, but sometimes the nurses forget to get it for me, other times the stool is tippy, so i can't use it, or if i need to use the foot pedal (eg. laparoscopic cautery, harmonic scalpel) you can't use a stool

Wow, this made my jaw drop. I'm 5'5 and several of my attendings are over 6'0, so I work on stools probably half the time or more. The table is set to the comfort of the operator - this is critically important. It has to do with how facile you are with you hands, the focal length of your vision, and being able to perform for hours without succumbing to cramping.

To hear the comment "the nurses forget to get it for me" is astonishing. That's like saying, 'the lineman sometimes forget to block the quarterback...'. When you are conducting the case, the ancillary staff are working in support of your ability to perform that case. One of our residents is about 6'5 - when he's scrubbed in, the entire OR crew, including the attending, are up on stools, so that he can work comfortably.

Also, the foot pedal goes right up on the stool with you, or sometimes I'll use two stools in continuity so I have more room to move around.

That's crazy, tussy. It sounds like they're treating you as if you're not even a member of the team.

 

[womansurg]

Originally posted by Geek Medic
I can be in the OR for 40 hours straight and still go home with a smile on my face. OK, so I'm psycho.

I know exactly what you mean, Geek . My husband can tell just how much operating I've done by how happy I am when I get home. That's great that you feel that way. People excel at what they love. You'll be a great surgeon.

 

[OwlMyste]

This question has bugged me ever since I can remember. I have watched shows to where the surgeons stand up the entire time, but it got me to wondering. Doesn't the Anesthesiologist sit down during the surgery while he is monitoring the patient? If he does, then I'm wondering if the surgeons can also sit down on a stool while at the surgery table and still do the surgery...you know, if the stool was screwed down to the floor or something. I'm just curious, because the question has been on my mind for quite some time now, and it would help me alot if someone in the surgical field would help me by answering the Question...Thanks!!

 

[OwlMyste]

Originally posted by Geek Medic
You were in the OR all day? Cool! I wish I had a day like that.

Being in the OR for 16 hours in a day doesn't bother me.

It's rounding, seeing new patients in the ED, etc. without going to the OR for 16 hours in a day that bothers me.

I can be in the OR for 40 hours straight and still go home with a smile on my face. OK, so I'm psycho.

One sentence describes you, Geek... "you are a Nut!"..LOL...All in good fun tho.. But I do agree with you, operating would be interesting, atleast its interesting for the shows I watch. its the rounding, as you say...(if it's what I think it is...) thats boring when you don't go to the O.R.

 

[surg]

Residency is indeed demanding. The days have their ups and down, but if you love it as the vast majority of us in the field do, we tolerate the downs to experience the highs (wow I sound like a drug addict!)

Height: I'm 5'9'' and find myself often on lifts for a number of our 6 ft attendings. tussy, you can set up lifts in such a way to get all your pedals up on lifts with you. Demand nothing less. Your back will not survive your residency if you don't.

owlmystere- I've often mumbled to myself after a particularly backbreaking stretch (anyone for a 6 hour adhesiolysis?) why we don't get smart like the ENT and opthy folks and design a stool that I can sit on. It would only really work though if it was mobile, because you will find yourself turning a lot of different ways to get the angle right to throw your stitches. It's kind of like tennis, you can hit just using your arm, but if you get your feet set before you hit the ball, it's a lot easier to make it go where you want (Andre Agassi notwithstanding!)

 

[OwlMyste]

Originally posted by surg
owlmystere- I've often mumbled to myself after a particularly backbreaking stretch (anyone for a 6 hour adhesiolysis?) why we don't get smart like the ENT and opthy folks and design a stool that I can sit on. It would only really work though if it was mobile, because you will find yourself turning a lot of different ways to get the angle right to throw your stitches. It's kind of like tennis, you can hit just using your arm, but if you get your feet set before you hit the ball, it's a lot easier to make it go where you want (Andre Agassi notwithstanding!)

Very true, surg...very true...I wish we could invent something like that, it sure would make it easier than standing for hours on end!!!!!!!

 

[droliver]

I think it depends on your expectations for residency. I've had a blast during my training & I enjoy the physical demands & intellectual stimulation. Having 2 kids now, my work out habits have gone by the wayside but I'm lucky in that I still have the "tapeworm" metabolism & now weight less now then when I was in college/high school. I also do not function without my morning caffeine anymore.

Now I'm pretty tired @ this moment- I've done as operating surgeon: 4 aortoa bifemoral,4 fem-distal bypasses, 3 AV fistulas with another fem-fem bypass & 2 AV fistulas on today over the last 7 days - but I really enjoy it (My wife however.... ) & love going to work every day.

 

[OwlMyste]

this may be off the subject....way off the subject....but I'm sure it's been wished b4. I just wish that Surgeons/Doctors could freeze time as many times per day as they wanted to while at work. Speed up time as well! That way being on call would be only like...5 minutes long...and you could freeze time in between operations and rest up for as much as you wanted, and when you unfroze time, you could go back to things just as it was, and your patients wouldnt suffer....wouldnt that be nice?

 

[womansurg]

Originally posted by OwlMyste
this may be off the subject....way off the subject....but I'm sure it's been wished b4. I just wish that Surgeons/Doctors could freeze time as many times per day as they wanted to while at work. Speed up time as well! That way being on call would be only like...5 minutes long...and you could freeze time in between operations and rest up for as much as you wanted, and when you unfroze time, you could go back to things just as it was, and your patients wouldnt suffer....wouldnt that be nice?

Nah, I mostly just wish for other superpowers...like being able to fly (think of how fast rounds would go!), or maybe tootling around in an invisible airplane.
Ollie...help....

 

[DoctorDoom]

Tussy, I agree with womansurg. If you are operating then the table should be adjusted to your height. If you aren't then you should have the stepstools placed there for you. Two banks if necessary to accomodate the footpedal. If it gets down to it get the stepstools yourself. But don't let them push you around. Unfortunately nurses and male residents will haze female residents, don't let them get away with it and hurt your body, or impair your operative needs.

That's my supportive quota for the week. Back to the regularly scheduled hardass surgeon programming.

Geek, hating endless rounds is fine, but remember that rounds are how you learn pre-op and post-op decision making and care. It is not just a hassle. And the ED teaches you when and if you should operate. That's more important a decision than the kind of incision you want to make. Ultimately surgery is about seeing patients. If you get into the mentality that rounds suck and you never want to see a patient, you won't like surgery and you'll have a real hard time making it through residency.

Owl, you're a high school student right? Guess what, surgery is not like TV. No kidding. Do some research before you post all of these questions. Magic powers? PA as an undergraduate degree? Getting huffy when the forum admins move your thread? Get over yourself. People here are nice, and that's great, but lose the attitude like people here need to respect you or something, because we don't. I ran a tight ship as a resident, and you would have been crushed underfoot. Spend your summer actually following a surgeon around, and you'll at least have some idea of what it's like.

And if you want to sit, be a bank teller. You want to be a surgeon? STAND UP, BITE DOWN, STOP SNIVELING.

 

[southerndoc]

Originally posted by DoctorDoom
Geek, hating endless rounds is fine, but remember that rounds are how you learn pre-op and post-op decision making and care. It is not just a hassle. And the ED teaches you when and if you should operate. That's more important a decision than the kind of incision you want to make. Ultimately surgery is about seeing patients. If you get into the mentality that rounds suck and you never want to see a patient, you won't like surgery and you'll have a real hard time making it through residency.

Doom, I'd much rather be in the OR... but the things you mention are important.

However, there are some rounds that are great, and some that are absolutely painful. Surgery rounds are usually a lot better because they go faster. Medicine rounds are a different story. That's one of the reasons why I'm choosing to go into surgery... because I can't stand sitting around talking about each patient for 30-45 minutes each debating the "finer" aspects of diabetes management or CHF management.

Some people love this, but I personally don't.

 

[DoctorDoom]

Hey Geek read my post, check my profile. I didn't choose surgery and trauma because talking about the NEJM for endless hours on a renal floor made me feel like a newly budding flower in the summer mist either. Just saying that rounds are important in surgery and to really try to SEE the patient. Guys used to blow through it all the time and sooner or later they miss something important and it comes back to bite them in the ass. More importantly, IT'S BAD FOR THE PATIENT.

This one time, in surgery residency, my chief, like, blew through rounds, you know, and like, he missed a dehiscence, you know, and I was careful, and like, actually took off the dressing, to look at the wound, you know, and guess what, I was covered in peritoneal fluid and blood. Holding SB in my hands. Stabilized her, dropped a triple lumen on the gurney on the way down to the OR, got yelled at for not using lidocaine when putting in the TLC.

It was cool.

 

[womansurg]

Originally posted by DoctorDoom
This one time, in surgery residency, my chief, like, blew through rounds, you know, and like, he missed a dehiscence, you know, and I was careful, and like, actually took off the dressing, to look at the wound, you know, and guess what, I was covered in peritoneal fluid and blood. Holding SB in my hands. Stabilized her, dropped a triple lumen on the gurney on the way down to the OR, got yelled at for not using lidocaine when putting in the TLC.

It was cool.

Doom, I'm curious. Quite frankly, and I don't mean this unkindly, you present yourself very much like a younger person, or someone less experienced. Sort of a anxious-to-impress-people persona like we sometimes see in medical students. I'm just trying to picture any surgeon whom I know - or even the junior level residents for that matter - who would think that a story about finding a dehiscience on rounds and putting in a line was even interesting, much less portray it as an exciting event.

I might be way off; certainly have been before. Maybe just a difference in communication styles. But, do I have it correct, that you are in practice as a general surgeon?

 

[DoctorDoom]

Anxious to please? where did you get that?... that was just my impression of the band geek from American Pie... poking a bit of fun at myself for trying to be like Moses to Geek... guess the impression didn't come off too well.

That story was from my 2nd month of internship or something... at the time it was pretty cool... much more bloody than it appears, and it's always sweet to nail your chief residents... I started using it as an object lesson to Geek about taking rounds seriously... and then said to myself "WTF? Who am I?"... hence the strange retelling. You caught the "eager beaver" approach, obviously.

I am actually not in practice. I decided that after training the best idea was to work in finance. Talk about bad choices...

Of course it could be that your junior residents and yourself are just that much cooler than I am... in which case... oh wait can't swear on this BBS right? Never mind.

 

[womansurg]

That was a very gracious reply . Welcome to SDN.

-ws

 

[southerndoc]

Originally posted by DoctorDoom
Hey Geek read my post, check my profile. I didn't choose surgery and trauma because talking about the NEJM for endless hours on a renal floor made me feel like a newly budding flower in the summer mist either. Just saying that rounds are important in surgery and to really try to SEE the patient. Guys used to blow through it all the time and sooner or later they miss something important and it comes back to bite them in the ass. More importantly, IT'S BAD FOR THE PATIENT.

I never advocated blowing off a patient exam or being thorough. I simply stated that I would much rather be in the OR than seeing patients in the ED or rounding. Where does that imply that I would much rather rush the patient to the OR without doing a thorough exam?

Why do you get the idea that I do not take rounds seriously? Just because I don't like long rounds and can't stand to be there for those long, boring rounds doesn't mean I don't take them seriously. I hate filing income taxes, but that doesn't mean I don't take them seriously.

I think you are reading into my posts way too much.

This one time, in surgery residency, my chief, like, blew through rounds, you know, and like, he missed a dehiscence, you know, and I was careful, and like, actually took off the dressing, to look at the wound, you know, and guess what, I was covered in peritoneal fluid and blood. Holding SB in my hands. Stabilized her, dropped a triple lumen on the gurney on the way down to the OR, got yelled at for not using lidocaine when putting in the TLC. It was cool.

I kid you not I thought you were going to say "This one time, at band camp, I..." Oh never mind.

 

[DoctorDoom]

No, I was just lecturing, so don't take me too seriously. I just saw a lot of that "get rounds over with" attitude and figured I would try to lead you on the right path.

But then I realized I was being a bit condescending. Hence, "This one time..." Indeed, I was doing the whole band camp thing... I'm glad it worked with you, if not with womansurg!