surgery core [x]

12 weeks of surgery is done. Next thing is the NBME exam, 100 questions, 2.5 hours.

edit: Shelf is done – I’m going to make yet another wonderful tab of shelf studying tips, books I used, etc.

pre-rounding

What is it? You, as the bottom of the totem pole medical student, should feel obligated to know as much about your patients as possible. Granted, there is some leeway when it comes to the service you are on and what is expected of you from the preceptor/attending/residents, pre-rounding is probably an essential part of your rotation. What this entails is going to the hospital even earlier than the residents or attendings do and seeing your patients for the day. How are they today? What problems do they have today? How has their treatment from the day before progressed? Are they recovering from surgery? If so, what kind of surgery did they have and how might you expect recovery to proceed? All of these things you want to consider as you approach a patient. Beyond the verbal exchange, it is also important to realize the patient interview begins as soon as you walk into a patient’s room. Is there an NPO sign on their door? precautions? Anything on their nightstand? What medications or fluids are on their IVs? How often are they receiving their pain medication? All of this is also important to give you the full picture of the patient, otherwise you might be missing important details. For example, there was a time that I was following up on a patient, and she was postoperative day two. As we left, my attending asked her how diet was. I was puzzled because we didn’t ask, but on the patient’s table was a protein shake. So that suggested the patient was able to tolerate fluids and moved to a full liquid diet. Make sense?

What pre-rounding does is that it gives you the chance to learn more about how your patient is doing so that if your preceptor starts to ask you questions, you might have already come to some conclusions or had insightful things to say, rather than leaving it strictly to the attending to give you teaching points. Did anything confuse you about the patient’s file? That’s a good time to ask while you’re reviewing it!

So that’s my two-cents on that. I’m biased because I pre-round and feel that it is an important part of the learning process in order to form my own ideas as if these patients were my very own.

rotations cont. and other rants

Approximately three weeks left in the rotations. What I have learned so far? My responsibilities have increased dramatically since the first couple of weeks when I was confused and wasn’t sure what was expected of me. Although I would have preferred to have a list of things expected of me and boundaries, I do appreciate this experience because it has given me motivation to learn to do something well and then try to master another thing. For example, I was really bad at tying knots, whether it was the two handed or the instrument tie. In some recent cases, I was expected to do both, and it felt like muscle memory to be able to do both ties as we finished with a case. I slowly find myself realizing that I have learned a lot of things, but still there is a lot of room for improvement too. My only hope is that I have been able to make a good impression if nothing else.

There is something about surgery that attracts me. Being able to treat people with your hands. I wouldn’t liken the field to playing video games, but to be adept with your skills is really important especially when you’re in precarious areas like the triangle of doom or near the aorta. Anatomy was a part of my first semester curriculum, and it was so mind blowing to be able to learn about the parts of the body. I was able to TA the class too, so that gave me a better appreciation for the field too and the anatomical variations in each body. Granted, this is my first rotation and so everything is interesting to me. I like the hospitalist aspect of it when we go pre-round/round, seeing patients progress throughout the day(s). I like being able to talk to them and figure out the surgical aspects of treatment for patients in this rotation.

I’m also studying for the surgery shelf exam. I have Pestana’s notes, MTB Step 2, and annotating UWorld questions into FA CK. NBMEs are available for $20 each with extended feedback on the same website that has the NBMEs for step 1. I did the first one on Sunday, and did well above the school’s passing score for it. I’m hoping to make an “honor’s” score, which I believe is above a 90. Fingers crossed.

I’m off to Maryland for IM and OB/GYN after surgery.

So that’s me in a nutshell. Random rants and thoughts.