What can an MS3 do on surgery clerkship?

[Al Pacino]

Ok, I'm on my third year surgery clerkship. I've been paired up with a general surgery attending who wants me to retract and cut sutures. This is an old attending who has been a surgeon since the 1970s. However, I've heard from classmates who have been paired up with other attendings that they've been allowed to "do more"-- whatever that means...

My question to you guys is: what can a third year medical student do in the OR? Am I relegated to retracting for 5+ hours a day and cutting sutures for the next grueling 4 weeks?

As it is now, I'm kind of bummed that I'm such a passive observor in the OR. I'm not asking to do surgery, but I feel so left out and bored

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[DO_Surgeon]

I'm not real sure what more you expect to do at this point being only a MSIII. During my rotation this past fall, I felt lucky to hold retractors, cut suture being that I had several friends and classmates tell me that they didnt get to scrub a majority of the cases due to the number of residents and other students on the service....Imagine that for 4 weeks My advice (being only a third year myself) practice your one-hand/two-hand ties and instrument tie and ask if you can do more (drive the camara, close lap wounds, close fascia and subQ, etc.) The worst that happens you get shot down, but he/she may like that you showed willingness and interest to learn. If given the chance...I would stick with the two handed tie, I almost got my head ripped off by my attending when I threw a couple of one-handed knots in during a case.

 

[doc05]

It depends upon where you do your clerkship/ with whom you are on a case. If it's a service patient, you will probably be allowed to do more than on a private. Even so, it's very attending-dependent. Often you are better off with a senior/chief resident, esp. if you have developed a good rapport with them. But even so, don't expect to do much more than close fascia/subcuticular/skin/etc.

and always use the 2-handed tie. It is a better and as medical students we haven't earned the right to use the 1-handed.

 

[Skialta]

I am an MS1 and was in surgery with a mentor for one of my classes. He stepped out at the begining of the case and the fellow let me actually open the chest of a TRAM breast reconstruction patient. I felt pretty lucky. I guess it is more on how you get along with the team and whether they trust you. Be interested.

 

[The_Id]

The majority of what 3rd years do is watch, retract, and cut sutures, but it is not too uncommon that they are allowed to suture skin. It depends on your attending or resident. If you want to maximize your chances to suture, you shouldn't be in on a Whipple or anything too hardcore. Instead, try to go in on really easy cases like lap cholecystectomies, breast excisions, etc... especially when there is no resident or intern on the case. I also found that plastic surgeons are often generous when it comes to teaching students how to suture. Another ideal situation is where the attending is the type who leaves the OR to let the resident close the incision... and if your resident is nice he or she will let you do some cool stuff.

 

[RADRULES]

Basically, your job is to be the scut b*tch. Cutting sutures and sewing skin is f*cking gay and anyone who finds that enthralling probably needs to get a life.

Remember, you are a scut b*tch.

 

[Smurfette]

I think it varies by school. At my school, M3's are expected to scrub 90%+ of the time. Usually it involves retracting, suctioning and cutting sutures, but usually here they let us do a few wound closures; some attendings and residents are awesome about getting the student involved and others are not. I've been first assist for brief periods a few times and got to use the Bovie to enter the abdomen, put in a few screws, and so forth. On neurosurg, I got to evacuate a subdural, Bovie off the bleeder and close the skull and scalp. My classmates have been allowed to drill the burrholes into the skull on occasion. It's also the M3's job to put in the foley, help prep the patient (SCDs, positioning), and so forth.

 

[FliteSurgn]

My advice is to keep your chin up and show your interest...Read about your cases, know the anatomy, and ask good questions. Definately try hooking up with a resident who has the patience to help you close skin etc. Some residents/attendings will be better about this than others, but if you continually show interest and know your ****, they should let you do something unless they are complete tools. Good luck.

 

[supercut]

It varies a lot depending on what med school. Retracting and cutting suture are pretty standard. Many places will also allow you to close skin for small incisions (especially the laparoscopic trochar incisions)

Some places, mostly with VA/County hospitals, may let you do more. At my med school, students did a lot of the ED suturing. They generally helped with closing any incision (eg on intraabdominal cases you would follow and hold the maliable retractor to keep the bowel out of the way). If you were doing well sometimes you'd be allowed to do some fascia closing (though you got to do that more on OB than surgery). Guillotine amputations were offered to students, and if you were doing well and asked, you might be allowed to do a lipoma or something. Students would be allowed to bovie an insturment holding a bleeder. And the 4th year students who were doing sub I's sometimes got to first assist trauma cases if it was really busy.

Don't dispair, though. Your experience is typical for most med students in the country.

 

[Pilot Doc]

... unless they are complete tools.

Which is a distinct possibility.

You operate at the whim of your superiors until you are an attending - an unfortunate fact of life. Some days are good, some days are bad. Being an intern is definitely better than being a medical student, though, and I'm told it continues to improve.