Friday, May 16, 2014

What do students do on third-year surgery rotations?

A woman who has been accepted by a few medical schools and is trying to decide which one to choose asks

What extent of involvement should be expected for medical school surgery rotations? I have enjoyed shadowing general surgery and feel that a field involving some procedure may end up being my fit, or at the very least something to enjoy in medical school. I am curious as to the type of participation in procedures (suturing/closing for example) that is typically allowed as a student versus that allowed and expected as a resident. 

In most third-year surgery rotations, students can do some suturing of skin and maybe lacerations in the ED provided the student has practiced knot-tying and using instruments outside of the OR. Opportunities to suture in the OR are fewer these days because of skin stapling and the use of glue, which are both faster than suturing. Hardworking and interested students are far more likely to be rewarded with things to do by residents.

Otherwise, there's a lot of camera holding for laparoscopic cases and retracting for open cases. Students used to do H&Ps and write postop orders but the electronic medical record has curtailed those activities greatly.

Medical school has changed a lot over the years. As a fourth-year student in the early 1970s, I placed many subclavian central venous catheters—some of which were unsupervised. Six years ago, I was about to let an intern place a subcutaneous chemotherapy port in the OR. It was halfway through the academic year. I asked her how many subclavian catheterizations she had done. She said she hadn't done any but had seen one.

I can't say whether that lack of experience is common to most current med students, but I think it may be.

Of course, residents get to do much more as they progress through the years. Residents in community hospital programs tend to do more cases during their first 2 years and often will have performed more cases over the 5-year course of residency training than those in pure university based programs. Of course, there are exceptions.

If this is really a major factor in your decision-making process, I suggest you try to talk to some students at the schools that you have been accepted by and see what they have been able to do during their third-year surgery rotations.

You will probably find that students who do third-year clerkships at community hospitals affiliated with med schools get to do more hands-on work too.

The same goes for those applying to residency. If you really want to know what goes on, talk to some of the residents who weren't chosen to meet the applicants on interview day.

I hope some of our readers will comment.

Thursday, May 8, 2014

US citizen IMG surgery prelim resident needs advice

Maicon, a non-designated preliminary general surgery resident, writes

I read with interest your post on matching rates for international medical graduates. I am a US citizen IMG, born here, but grew up (since 2 years of age) in another country and completed my medical school there a few years ago.

My USMLE scores are step 1 - 235, step 2 - 251, Step 2CS and Step 3 passed on first attempt. Knowing that general surgery was hard to get, I worked (unpaid) in the surgery department at a large Northeastern academic center.

I got a prelim spot at a decent program with a program director I respect. I worked my ass off, studied hard, and got in on research projects early.

ABSITE: 1st year - 90th percentile (highest in our class), it got me a 2nd year at the same program, 2nd year - 79th percentile.

Did a ton of research with a couple of publications and presentation, and won a teacher award by med students. My evals were good, and I got great recommendation letters. I thought I covered my bases.

My program doesn't have a spot for a 3rd year and am unable to find one, despite the good intentions of my mentors. It is frustrating that, try as I might, I am still out of a residency on June 30th of this year.

Should I continue to pursue the surgical field, do a research fellowship which I have seen from previous blogs/articles doesn't help much, do a subspecialty fellowship (Cardiothoracic ICU/critical care/Burns), or switch to medicine or FP? From, your previous posts, I feel you will probably suggest to switch.

Thanks for reading my blog and for your email. I am sympathetic to your plight. I've seen it many times.

I wish I was still running a program. It sounds like I could have used someone like you.

If you have no financial or other pressure to get on with your life and are young enough, I suggest you take a fellowship in one of the clinical areas you mentioned such as critical care. An accredited one is preferred because you could take the board exam when you finally get through a 5-year GS program. Even a non-accredited fellowship in a clinical area is better than doing research. Your chances of obtaining a categorical spot are enhanced by taking care of patients instead of test tubes.

 If you do a good job with the fellowship, you might be able to sneak into a categorical slot somewhere. Make sure you take the ABSITE again too. The scores are really important.

Have your program director keep an eye on the program directors' list serve. Categorical slots open up frequently—even into June.

Good luck.