Sunday, August 25, 2019

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As a third year medical student, I've been through 2 years of basic science studies and passed USMLE Step 1 before being certified to start clinical rotations. If you're not familiar, clinical rotations are where a medical student finally gets to actually work in the hospital day-to-day. Every medical school has a set of required "core rotations" that students are expected to complete during their third year. These include Internal Medicine, Family Medicine, Pediatrics and OB/Gyn, Psychiatry, Emergency Medicine, and of course Surgery for most students. Basically, third year is a grand tour through a wide swath of medical specialties during which students are expected to learn the ropes of practical patient care and management, and (hopefully) find which specialty they intend to pursue in their career.

This is my second core rotation; 3 months in Surgery

As you can see here, the schedule for this rotation is packed, with each day starting early and ending late (if it ends at all). Rather than go through this one day-by-day, I'll just explain what each color coded item actually is.

Morning Pre-rounds 4am-6:30am

Mon-Fri students are responsible for seeing up to 4 patients (its up to 6 on the weekends) whom we then present to our Residents either during table rounds at 6:30 or later during teaching rounds.

Morbidity and Mortality Conference

This is a departmental meeting during which residents present on challenging cases they have faced recently, and discuss any mistakes or opportunities for improvement. These meetings can be intense, with residents getting absolutely skewered by the attendings. The takeaway message from each presentation is simple; NEVER DO THAT AGAIN.

Teaching Rounds

During this time, students follow the residents around the wards as they round on each patient. Residents answer any questions students have about patient care, and show students some practical aspects of handling patients.

Surgical Consults

As the day progresses, residents message or call students and assign surgical consults requested by other services. Usually, the residents have determined that the consult is within student's capacity to handle, and the student is expected to see the patient and do a full workup, then present to the resident.

Operating Room Cases

You can see these in purple throughout the schedule. Operations come from my attending physicians OR schedule. Each day, the scheduling board is updated, so these operations (or "cases" as they are called in surgery) can change. When a scheduled surgery is coming up, students decide whom is going to scrub in, and that student then goes to the operating room wing, and scrubs into the theater. During surgical cases, the attending may (or may not) bring the student in the assist with holding instruments or or even helping to cut and suture depending on their level of skill.

Surgery and Wound Clinic

Once a week, each student's attending has clinic scheduled. During this time, students report to the outpatient surgery clinic, where patients come in as new patients, post-op follow ups, wound care visits, or other non-emergent cases. Students are kept very busy during this time, often seeing 10-15 patients each during the day. After seeing each patient and writing up an HPI, ROS, PE, and Assessment and Plan, students present the patient to a resident, who then sees the patient along with the student and takes over their care.

This is my life now

I've previously written about my Internal Medicine rotation schedule here. That experience was heavy on the academics, and really helped me dig into clinical decision making. The next three months will no doubt be a challenging time for me, especially with the long hours. I look forward to it though, and I know that I'll have learned so much through this rotation.

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