Trauma

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Perrotfish

Has an MD in Horribleness
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I'm currently 3 courses into my 3rd year, but I already know that I would like to spend at least 4 and ideally 8 weeks of my 4th year getting experience with Trauma. I've done searches online and the best reviews I've found were for some programs abroad (particularly a program in Johannesburg) and the Trauma center associated with the University of Maryland. I am willing to travel and while I won't go so far as to say money is no object I am willing to drop some $$ on this. I want to work hard, do procedures, and be treated as much like a physician as possible. I don't want to be one of 10 medical students crowding around the same patient.

So, SDN, any suggestions/reviews for Trauma electives? Also I've noticed that many electives have both a TICU and a Trauma bay option. Right now I'm thinking a 50/50 split, but does anyone have experience that it would be best to focus on one or the other?
 
I am a student at University of Maryland. I have not done my mandatory 2 weeks in trauma during my 3rd year, but have heard nothing but amazing things about it. Maryland is the place to do trauma. The way it is structured from what I understand is there are 2 med students on the team (3rd years) and then a sub-I possibly. So its not a huge number. My experience with other rotations at Maryland is they let you do stuff especially if you're willing to. I recommend it, the hospital is pretty awesome and the trauma center is awesome.
 
mandatory 2 weeks in trauma, that's awesome. my school does not have that.
 
mandatory 2 weeks in trauma, that's awesome. my school does not have that.

My school has mandatory time in trauma as well. Half the rotation general, half trauma. Trauma call was a sh.itshow at times but it was awesome. Level 1 trauma center, saw some absolutely crazy stuff - brain hanging out, did chest compressions on someone with a GSW to the chest, ex lap on a guy who had damage from a GSW to his IVC, SMV, SMA, transverse colon among other things (on my 1st night nonetheless)

To the OP - I had a great experience at a Level 1 Trauma center in a major city (Top 10 Metro pop) but I glanced around and didn't find any pure trauma electives for 4th years. PM me if you want any more info
 
then go here:

http://en.wikipedia.org/wiki/Chris_Hani_Baragwanath_Hospital

by talking to the people here:

http://web.wits.ac.za/Academic/Health/Students/Elective/GeneralInformation.htm

Overseas and expensive, but one of, if not, the busiest trauma center in the world. Just sayin'.

I saw that one. I'm definitely considering it, but the HIV thing worries me. On the other hand it looks amazing. I apparently need to apply a year in advance, though, so I'd basically need to decide now.

Does anyone have any experience with this program?
 
Much of Maryland's patient population is HIV/Hep C positive as well.
 
Trauma Surgery is awesome, but it depends on where you are. At my school, medical students aren't allowed to participate during the primary and secondary evaluations. So after you have seen a few dozen major traumas, they get really boring unless you are allowed to be involved. If the pt has to goto, surgery immediately, usually you can go and watch but good luck being able to scrub in if you have residents and fellows nearby. Nurses will run out anyone in the room that they don't think should be there, so prepare to stand your ground.
 
Trauma Surgery really is the shiznit, its where boys become men...and I say this not because of what you see or what you do, its because trauma call is insane!

Im an currently a 4th year and I have 3 trauma surgery sub-i's scheduled. I finished the first one at UMass Worcester (level 1 trauma center) in September, am half way through Trauma at Mass General - Harvard Med and then have another month at Baystate - Tufts Med. All three are pretty good and high volume trauma centers, like all trauma centers blunt trauma > penetrating trauma.

To go back to what I mean by "where boys become men..." the call schedule is crazy. I did 12 hr shifts 6 days a week at UMass, alternating days and nights. At Mass General I do 24 on/24 off (in reality its like 28 on/20 off) and its brutal. No time for anything else really except work.

From my experience as a 4th year Sub-I, its more about showing your stamina and ability to just pound out scut work during trauma, which gets you noticed. Lets be honest, we wont be intubating, EM and surgery residents are all over that. We wont be putting in chest tubes..EM and surgery residents will be over that (usually). I was promised a chest tube, but then the patient desaturated and it got yanked from me.

With that said, I have dont some pretty cool stuff...multiple needle decompression for tension PTX, scrubbed in on many ex-laps, where mostly i help close when the attending leaves. Do suture and lac repairs like its my job, both simple and complex (with "supervision"), A-lines and a femoral central line

the coolest thing probably was at Mass General when i got to go up to the helipad and hop on the chopper and get on the stretcher to do chest compressions the entire way down into the trauma bay, like something out of a movie...pretty cool

Ohh ya, I get to do a half dozen or more FAST exams a shift, but you can never get enough of those in.

I guess at the end of the day, its what you make of it. If you sit there expecting someone to be like "hey come do his lac repair" it wont happen. You have to be a little aggressive and ask to do stuff. Procedures get picked up left and right.

**best advice is to be kind to the nurses, introduce yourself the first day and show them your willing to help with anything (i mean foleys, IV's, blood draws) because they will be the ones that will not kick you or shove you out of a room when a trauma comes in.

Good luck
 
"All trauma, all the time."
 
To go back to what I mean by "where boys become men..." the call schedule is crazy. I did 12 hr shifts 6 days a week at UMass, alternating days and nights. At Mass General I do 24 on/24 off (in reality its like 28 on/20 off) and its brutal. No time for anything else really except work.

Sweet mercificl crap this sounds awful.

NJ thank you VERY much for your commetary, it really helped me understand what I should expect and where I should consider going (I'm about 95% that I'm going to South Africa right now). Is there anything, other than an ATLS course, that you'd recommend I do or read to prepare? Are there any good textbooks or Qbooks you'd recommend for Trauma?
 
Trauma Surgery really is the shiznit, its where boys become men...and I say this not because of what you see or what you do, its because trauma call is insane!

Im an currently a 4th year and I have 3 trauma surgery sub-i's scheduled.

This sounds like a great waste of fourth year of med school. The point of your year is not to have a mini-trauma internship. I would recommend adding some diversity to your year.

Even if you are going into general surgery - I would want to see that you have exposure to something more than just trauma.
 
This sounds like a great waste of fourth year of med school. The point of your year is not to have a mini-trauma internship. I would recommend adding some diversity to your year.

Even if you are going into general surgery - I would want to see that you have exposure to something more than just trauma.

I personally think that's the most productive fourth year of medical school I've ever heard of. My impression was that the 'point' of 4th year is for your medical school to fleece you for one last year of tuition despite neither providing nor expexting you to recieve any education. Most of my 4th year friends consider it a bad week when they work for more than 20 hours.

Anyway my personal interest is that I'm military and I've heard some horror stories about the military dropping GMOs (people who are practicing after just doing an Intern year rather then a full residency) in places where they got to see acute trauma and, more importantly, are responsible for training corpsmen for acute trauma even though their only trauma training was a 2 day ATLS course. I want to not be that guy, so a mini Trauma internship sounds pretty good.
 
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I personally think that's the most productive fourth year of medical school I've ever heard of. My impression was that the 'point' of 4th year is for your medical school to fleece you for one last year of tuition despite neither providing nor expexting you to recieve any education. Most of my 4th year friends consider it a bad week when they work for more than 20 hours.

I'm all for getting the most out of fourth year that you can; in my opinion it is just a waste to spend so much of the year focused on one aspect of one field (with the possible exception of fields like ortho or plastics where 2-3 away rotations are expected to maximize your chances of matching). I would think it just as odd if I saw a fourth year who did three months of surg onc or transplant.

Fourth year is unique in that you have a wide range of opportunities/resources and relatively little time pressure. Take advantage of it to broaden your education a bit, IMHO.

Additionally, for all this bragging about being "hardcore" and learning a ton as a sub-I on trauma...I guarantee you will learn more in the first two weeks of a trauma month as an intern than in all these experiences combined. The learning curve changes next year.
 
I actually go to Wits (University of the Witwatersrand). There is probably no place better in the world where you can do trauma... I am just finished my second year, so we haven't really been in hospitals yet. But some of the people that I know have tons of stories. New years eve at Bara (Chris Hani Baragwanath) is probably one of the most insane things you will ever experience. Axes in heads, gun shot wounds etc. Gun shot wounds here are common, so you will get a lot more experience here.

I can speak to people here if you want to find out more.

The HIV thing can be a bit of an issue, but you double glove etc. And they have good insurance for needle sticks (i.e. you get PEP immediately)
 
Ask me questions and I will find out 🙂.
 
Ask me questions and I will find out 🙂.

Alright:

1) First and foremost, how safe is it both in and out of the hospital? I'm especially curious about your classmates who went to Bara. Also where do you live when you're at Bara?

2) How many procedures did they get to do? Did medical students in either Johannesburg General or Bara get a chance to do things like chest tubes, needle decompressions, etc, or was it more of a watch and learn kind of thing?

3) Is there a didactic program associated with Trauma or is it pretty much work and sleep?

4) What's the schedule for a student on an elective? Is there a difference between an elective and a SubI or are all foreign students rotating through considered to be SubIs?

5) What are the hours like? Are there days off? Do rotating medical students have any say in their schedule?

6) How much of a difference is there between Bara and Johaannesburg? Which would they recommend?

7) Do students rotating through normally have some Trauma before they arrive or is this the first time for most of them?
 
Will have answers for everything tomorrow I think. My friend's computer was struck by lightning...
 
Alright:

1) First and foremost, how safe is it both in and out of the hospital? I'm especially curious about your classmates who went to Bara. Also where do you live when you're at Bara?

As with anywhere in South Africa there are always safety concerns. More so with a place like Bara where it's very open to public access. My advice to you is always be vigilant. Things are generally fine during the day and in the wards but when leaving at night just be extra careful as there are always risks. There is no formal accommodation for students on the premises as far as I know. It is best to arrange your own private accommodation away from the vicinity of the hospital as it is not situated in the safest of areas.

2) How many procedures did they get to do? Did medical students in either Johannesburg General or Bara get a chance to do things like chest tubes, needle decompressions, etc, or was it more of a watch and learn kind of thing?

Teaching is very hands on, more so at Bara than at the Gen. There is the opportunity to perform simple procedures as long as you assert yourself.

3) Is there a didactic program associated with Trauma or is it pretty much work and sleep?

In theory there should be a teaching program. But as with all things practice never quite follows the theory. In short it pretty much depends on the senior staff on duty at the time. Some are very good in that regard and will give of their time to actually teach you but sadly others are not so good.

4) What's the schedule for a student on an elective? Is there a difference between an elective and a SubI or are all foreign students rotating through considered to be SubIs?

What is a SubI?

5) What are the hours like? Are there days off? Do rotating medical students have any say in their schedule?

For an elective student the hours are not too bad. You will be required to be on call for a certain number of hours per week in addition to your normal daily hours and there are days off. I'm not entirely sure about how rotating students are fitted in but I assume that you will be able to coordinate with other students to a certain extent as long as you fulfill your minimum requirements.

6) How much of a difference is there between Bara and Johaannesburg? Which would they recommend?

You will definitely get to learn more at Bara than at the Gen. The gen is way too overpopulated with consultants and residents, so students don't really get a chance to do stuff themselves. In contrast, Bara has fewer senior doctors so you get the opportunity to perform procedures and the doctors guide you instead of just doing it themselves.

7) Do students rotating through normally have some Trauma before they arrive or is this the first time for most of them?

I haven't really spent time with many of the rotating students, But from what I can gather it tends to vary. It's not a prerequisite as far as I know, but the level of previous experience differs.


Sorry about the extremely late reply. My friend forgot to give them to me.
 
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