Now that I am out of medical school and residency, keeping up with my reading and study has become a major goal for me. I usually keep a weekly log of articles and book chapters that I have completed. For instance, I have been reviewing the medical treatment of esophageal disorders today. In addition to my last evening's read of the appropriate chapter in the latest edition of Sabiston's, I tend to keep my medical reading as up to date as I can. While Sabiston's is a great general surgery resource, I do find that reading in Harrison's Principles of Internal Medicine provides an in-depth review of physiology and pharmacology. I also tend to read from 20 to 30 journal weekly in addition to my textbook reading. The question would be, "Why do all of this work now that I am out of school?"
As a professor, I need to keep ahead of the textbooks on many topics. Human beings are incredibly complex entities that regularly present their physicians with diagnostic dilemmas. I have found over the years, that my diagnostic skills have greatly improved with both experience and reading. I find myself looking forward to my time with the "pulps of medicine" as being able to constantly learn and assimilate information is crucial to me in navigating those diagnostic dilemmas. There is always some new theory or different way of looking at a disease entity that I find interesting. Since medical school, I could never get enough of New England Journal of Medicine or Nature Medicine as a student. One of my internal medicine professors encouraged us to read journal (as much as we could between coursework study) in order to develop an early grasp of the language of medicine. It turns out that old habits die slowly for me which is a good thing in terms of journal reading.
Most weeks I will have an undergraduate student or two drop by my office to discuss entry into medical school. One of the first things that I encourage for these folks (not New England Journal of Medicine or Nature Medicine; these are better utilized in medical school) but just to read a variety of types of literature (scientific and non-scientific) from a scholarly perspective. Regular critical reading encourages regular critical thinking which is integral to the practice of good medicine. There will be plenty of opportunities to read medical journals in medical schools (great libraries online and on site) but training your mind to handle different types of writing is a good skill to have as an undergraduate. Most undergraduate college libraries have a wealth of well-written scholarly journals that are great to keep up with.
In addition to reading the scholarly journals, pick up a couple of newspapers (New York Times, Richmond Times-Dispatch, Wall Street Journal) and read the editorial pages. Most editorials are short and very well-written in the three newspapers that I have listed in the last sentence. The New York Times and Richmond Times-Dispatch are both published online for easy access. In addition to the editorials, compare how major front-page news stories are handled. Do both papers have the same stories "above the fold" on the front page? Look at your local newspaper, even if are from a smaller locale such as the Falls Church News-Press or the Marin Independent Journal to see how your local events are covered and discussed. The Marin Independent Journal is one of my favorite reads along with the San Francisco Chronicle as both newspapers provide a welcome change for my brain as I move through my weekly medical journal reading.
Being able to read efficiently and comprehensively is a habit that can be honed by regular practice. Just as walking/jogging on the treadmill or listening to my favorite recording artist is welcome change from my daily work routine, my journal and newspaper reading are welcome habits that I enjoy. It's great to utilize the social media such as tweeting and blogging but the best reads are still those that explore a subject (medical or otherwise) from a comprehensive standpoint. You won't get a comprehensive view of a topic from Twitter but you will get great opinions from that website. Blogs are also great for both opinion and information but force yourself to think creatively and comprehensively even when you are reading your scholarly journals.
Many people will say that they just don't have the time to do much reading outside of work. I generally find that I can make use of my "down time" when I am waiting for a patient or something else. I always have an article or two in my lab coat pocket for those stray minutes. I do find that I have to "mark my progress" so that I am not reading the same sections over and over. I have a list of my regular journals and then I have the journals that I scan sporadically for a change of pace. Most of the time, if a subject is getting loads of press in one journal, it's getting mention is many journals. Knowing what's "hot" is just one of the great aspects of regular journal reading. I also find that when the Nobel Prize winners are announced, I generally have some knowledge of their work from my journal reading.
If one keeps in mind that it takes approximately 2 to 5 years for something to become established enough in the journals to become published in a textbook, then the utility of regular medical journal reading for the physician becomes important. While I make my yearly read of Sabiston's, Cameron and Greenfield, I find that my journal reading enriches those topics that I encounter in the text. Regular reading when I was a resident, made study for the "in-service" exams much easier than some of my colleagues would find. Residency is the ultimate learning experience because one is learning both from a practical standpoint and from a scholarly standpoint which is the only time in training that you will have both types of learning so intimately connected. Journal reading during residency is an integral part of the process.
If you hang around me for any length of time, you will find that I have a journal article or book chapter in my hand/pocket most of the time. Over the holidays when I was traveling thorough some of the wonderful airports of New York and Chicago, I was able to get my journal and textbook reading off to a good start. Since there is so much waiting involved with air travel, having a good read is a necessity. I keep my Amazon Kindle jammed with .pdf copies of articles and chapters for airplane reading in addition to my paper copies of one or two things (they tell you to turn off all electronics until 10,000 feet). In short, I always have something to read.
Showing posts with label surgical residency. Show all posts
Showing posts with label surgical residency. Show all posts
08 January 2011
18 July 2008
Why I chose Surgery (Part 1 and Part 2)
Part I (an earlier post)
I can vividly remember starting my third year of medical school. My school chose our third-year schedules for us and I remember some of the angst of my fellow classmates when our schedules were posted during the summer between our second and third years. I was in the midst of a wonderful Pathology fellowship that I had received for scoring very high in my Pathology course. I was assigned to various Medical Examiners offices and to the Pathology Departments of a couple of very large teaching hospitals. I had been spending the summer doing everything from crime scene investigation to transfusion medicine to bone marrow transplant. It had been a great summer. I was very strongly considering Pathology and Transfusion Medicine as my specialty.
I stopped by my Dean of Academic Affairs office and was told to wait for my USMLE Step I scores. The school had received them before I had received them. I took a deep breath because I really hadn't prepared myself for facing the prospect that I might have failed that test. I sat in a chair outside the Dean's inner office and ran a couple of scenarios as to what I would do if I had failed. I would quickly sign up for a retest and I would only miss one rotation at the start of third year. Since I was doing Pathology, I could study in between cases and get my preceptors to help me with covering the material.
The Dean came out and handed me a sheet of paper. I had to just sit there in disbelief. Not only had I passed, I had done extremely well. I was on my way. It was hard to hold back the tears of joy because I had studied about two and a half weeks for Step I. My fellowship had the requirement that I take Step I by the second week in May and my last exam from second year was on April 28th. I would be starting third year and I would be starting third year on Pediatrics with one of my best friends as my rotation partner. Life was good... I found out later that two people from my class did not pass USMLE Step I. It was very sad because one girl ran down the hall screaming and sobbing when she received her score. That put loads of people on edge.
I started third year on Pediatrics. It was a good rotation and I received Honors. I really enjoyed taking care of patients and I was very popular with the residents because I could place IVs and draw blood. I had also spent loads of time with an excellent pediatric pathologist so I knew my congenital defects inside and out. I could interpret cath reports and I was quite comfortable in the Pediatric Intensive Care Unit. I had been a Pediatric-Perinatal Respiratory Therapist before starting medical school so the interns found me quite useful.
My second rotation was Psychiatry. This was one of my best required clerkships. I knew that I wasn't going into Psychiatry (you know these things early) so I was free to enjoy the rotation and pick up anything that I could. My preceptor was an excellent Consultation-Liaison Psychiatrist who exposed us to everything from the wards for the criminally insane to hard-core substance abusers to schizophrenics and other stuff. I earned another Honors grade and got some excellent experience. I learned above all that I was not crazy, my friends are not crazy because I spent loads of "quality time" around people who were genuine crazy.
My third rotation was Family Medicine. I had a great preceptor who even delivered babies. This rotatations was entirely office based but I learned to do prenatal exams and care for entire families. I also learned how and when to refer which is great stuff to know. My preceptor was extremely brainy and "pimped" me on just about everything. Turns out this was a good test for USMLE Step II because we either discussed or I had to report on most everything in Family Medicine that was on the shelf exam or on USMLE Step II. I received Honors for this rotation but decided that I really did not enjoy being out of the hospital too often. I also did not enjoy the slow pace of the office.
Holiday break came and I was happy to be done with shelf exams and rotations for five weeks. I knew that Surgery was coming up and my friends had warned me to be ready for two months of pure hell. The rotation is designed so that you spend your first month on General Surgery on one of two services: Trauma or General Surgery. I drew Trauma out of the hat and I received the condolences of my classmates. I figured, "you can do anything that you want with me but you can't stop that clock." No matter how bad, in four weeks, it would be over.
I was hooked on Surgery from my first case. It was a total colectomy with four females operating. My chief resident was female, the junior resident was female, the attending was female and I was female. We talked about shoes and Chanel suits during the case. I tied tons of knots and helped the junior resident close the incision. It was heaven. I found out that I loved Trauma and I couldn't wait to be on call every third day. I had the time of my life and I loved everything about surgery.
My next month was spent on ENT and then on Cardio-thoracic and Vascular Surgery. I scrubbed every case that was assigned to me and many cases that were assigned to some of my colleagues. I became hooked on Vascular Surgery during that rotation. I loved the detective atmosphere on Vascular and loved taking care of the patients. My chief resident on Vascular taught me some great pearls about making sure that even with an amputation, fashioning a well-constructed stump can make the difference between ambulating and not ambulating for the patient. It was great stuff.
After Surgery, I rotated through OB-Gyn. I hated everything about this specialty. This rotation became my only High Pass during third year. I just couldn't get into delivering babies and I wasn't thrilled with tubal ligations. I wasn't thrilled with spending too much time in the clinics and offices. The one bright spot was the Gyn surgeries which I excelled at. I learned the surgical anatomy like a sponge but I knew that this was not going to be the specialty for me.
I finished up on Medicine and Neurology. This would be my final sixteen weeks of third year. I was fortunate to have medicine last because this made study for USMLE Step II a snap. I totally enjoyed Medicine and Neurology but my heart was back in surgery. All of my Pathology experience really paid off because I aced these rotations and moved onto fourth year.
My faculty adviser was chairman of surgery and helped pave the way for my entry into this specialty. I was also co-president of the Surgical Society during my fourth year which also helped. My USMLE scores were good so this helped too. I had some awesome interviews and I landed at a great residency program. My experiences began there and they keep on.
As I continue to write, I will be posting more of my experiences.
Part 2 Why I chose Surgery.
As I moved through medical school, I knew that any specialty that I would enter had to have the following aspects:
Ability to have long-term relationships with patients
Ability to see every type of patient under a variety of circumstances
Practice in office, clinic, hospital, intensive care, operating room and emergency department.
Ability to handle a wide variety of clinical conditions
Ability to deal with both acute and chronic conditions
Ability to perform many procedures
The only specialty that met all of those requirements for me was Surgery. I also loved the aspect that I had to utilize my knowledge of both medicine and physiology to the surgical patient both preoperative and postoperatively. This was very appealing for me. I also utilize pathology and biochemistry to a great degree especially in my teaching of surgery and surgery practice. Again, this made surgery a very attractive specialty.
I definitely started out in residency with a strong interest in vascular surgery. Not only were the vascular surgical patients among the sickest in the hospital on any given day, I also loved seeing the immediate aspects of my work. Once you increase blood flow to an extremity that had previously been lacking blood flow, you see the immediate effects both good and bad. I also liked becoming very familiar with wound care and the healing of chronic wounds.
I had heard about the "surgical personality" and that some surgeons were very difficult to deal with but that never became a factor in my choice of specialty. I don't care if the devil himself is teaching me if the teaching is good. Fortunately for me, that was rarely the case and my knowledge base expanded exponentially with every year of training. Good teaching is good teaching and good faculty allow you to grow and learn from both them and your mistakes in a constructive manner. I also found that I could profit from the mistakes of others at time too.
The other factor that did not deter me from surgery was the horror stories that I had heard about the residency experience. Yes, sometimes I had to work long hours but those long hours yielded some of the best teaching of my life. Yes, I did miss parties and social events but that happens with any aspect of medicine and comes with the territory. Physicians often work long hours taking care of patients who are sick. If you don't like to take care of sick patients, medicine/surgery is not the career for you.
Finally, I have a very good life. I do something that is very interesting and I give my patients 100% at all times. I have encountered some physicians who were psychotic, neurotic, dishonest, unprofessional, racist, sexist, anti-Semitic and just down right stupid. The interesting thing is that I am none of those things and my life is good. Good will goes out from me to my patients and it come back to me in droves. Yes, I work very hard and under extreme conditions at times but I have been blessed with an even temper and a love of my fellow humans.
If you choose a specialty, choose for what you know that you will enjoy doing in most aspects for the rest of your life. If not, you have many years of misery ahead of you. Conditions of practice will change and your income is largely based, not in how hard you work, but on what third-party payers are willing to pay for your services. If you can't deal with this aspect of your chosen profession, get out as soon as you can.
If you choose a specialty because the rest of your classmates were in awe of you, you are likely going to be very unhappy in that specialty. Specialty choice is personal and your classmates will not be entering residency or practice with you. You, and not your classmates, will be the person at 0400h who is admitting that patient with the chronic condition, thousands of medications and multiple needs. You have to love that aspect of medicine/surgery as much as you love the other aspects of medicine/surgery.
Finally, you have to be a ethical and honest person. Showing up at the church door every Sunday does not make you a moral person if you know that deep inside yourself, you couldn't be honest with yourself, your patients or your colleagues. You may not "like" everyone that you work with or work on but you have to have respect for them and give them your best. In short, you can't be having a "bad day" unless you are on vacation. If you are prone to allowing external influences to influence you internally, you are going to have a difficult time medicine/surgery.
Especially with surgery, you will find yourself multi-tasking, juggling six or seven balls at once, shifting up and shifting back on a daily basis. That's the nature of the work and the challenge of the work. If you can't do this, surgery is going to be tough for you on a regular basis. In short, I have never had a day that was strictly "routine" unless I was just teaching for the entire day.
Finally, take some time and get to know yourself and your career needs because after all, this is YOUR career. Your parents, your significant other, your classmates or anyone outside of yourself, can't make this decision for you. You have to know your competitiveness for certain specialties (forget derm if you struggled with every aspect of medical school including boards) and you have to have a good idea of how competitive you are for programs within that specialty.
Also, remember that while residency is when you will hone your skills, it is a short period out of the length of time that you will actually practice those skills. Again, I heard that surgical internship was the worst time on earth but I actually enjoyed my experiences during internship. I heard that surgical residency was the worse time on earth but it wasn't. No residency program is going to be perfect but unless you encounter dishonest or illegal activity, you can live with residency. The clock is always ticking and time passes (quickly in most cases).
Residency requires hard work and hard study. In my case, during my first two years of residency, I studied far more than at any point in medical school in addition to getting my work done. At times, I was "bone tired" but I made myself read and study (minimally for 30 minutes daily). No, I didn't get to the gym as often as I would have liked and I didn't hang out late at night (outside the hospital) but I did live pretty well and my significant other saw as much of me as he could stand anyway.
I can vividly remember starting my third year of medical school. My school chose our third-year schedules for us and I remember some of the angst of my fellow classmates when our schedules were posted during the summer between our second and third years. I was in the midst of a wonderful Pathology fellowship that I had received for scoring very high in my Pathology course. I was assigned to various Medical Examiners offices and to the Pathology Departments of a couple of very large teaching hospitals. I had been spending the summer doing everything from crime scene investigation to transfusion medicine to bone marrow transplant. It had been a great summer. I was very strongly considering Pathology and Transfusion Medicine as my specialty.
I stopped by my Dean of Academic Affairs office and was told to wait for my USMLE Step I scores. The school had received them before I had received them. I took a deep breath because I really hadn't prepared myself for facing the prospect that I might have failed that test. I sat in a chair outside the Dean's inner office and ran a couple of scenarios as to what I would do if I had failed. I would quickly sign up for a retest and I would only miss one rotation at the start of third year. Since I was doing Pathology, I could study in between cases and get my preceptors to help me with covering the material.
The Dean came out and handed me a sheet of paper. I had to just sit there in disbelief. Not only had I passed, I had done extremely well. I was on my way. It was hard to hold back the tears of joy because I had studied about two and a half weeks for Step I. My fellowship had the requirement that I take Step I by the second week in May and my last exam from second year was on April 28th. I would be starting third year and I would be starting third year on Pediatrics with one of my best friends as my rotation partner. Life was good... I found out later that two people from my class did not pass USMLE Step I. It was very sad because one girl ran down the hall screaming and sobbing when she received her score. That put loads of people on edge.
I started third year on Pediatrics. It was a good rotation and I received Honors. I really enjoyed taking care of patients and I was very popular with the residents because I could place IVs and draw blood. I had also spent loads of time with an excellent pediatric pathologist so I knew my congenital defects inside and out. I could interpret cath reports and I was quite comfortable in the Pediatric Intensive Care Unit. I had been a Pediatric-Perinatal Respiratory Therapist before starting medical school so the interns found me quite useful.
My second rotation was Psychiatry. This was one of my best required clerkships. I knew that I wasn't going into Psychiatry (you know these things early) so I was free to enjoy the rotation and pick up anything that I could. My preceptor was an excellent Consultation-Liaison Psychiatrist who exposed us to everything from the wards for the criminally insane to hard-core substance abusers to schizophrenics and other stuff. I earned another Honors grade and got some excellent experience. I learned above all that I was not crazy, my friends are not crazy because I spent loads of "quality time" around people who were genuine crazy.
My third rotation was Family Medicine. I had a great preceptor who even delivered babies. This rotatations was entirely office based but I learned to do prenatal exams and care for entire families. I also learned how and when to refer which is great stuff to know. My preceptor was extremely brainy and "pimped" me on just about everything. Turns out this was a good test for USMLE Step II because we either discussed or I had to report on most everything in Family Medicine that was on the shelf exam or on USMLE Step II. I received Honors for this rotation but decided that I really did not enjoy being out of the hospital too often. I also did not enjoy the slow pace of the office.
Holiday break came and I was happy to be done with shelf exams and rotations for five weeks. I knew that Surgery was coming up and my friends had warned me to be ready for two months of pure hell. The rotation is designed so that you spend your first month on General Surgery on one of two services: Trauma or General Surgery. I drew Trauma out of the hat and I received the condolences of my classmates. I figured, "you can do anything that you want with me but you can't stop that clock." No matter how bad, in four weeks, it would be over.
I was hooked on Surgery from my first case. It was a total colectomy with four females operating. My chief resident was female, the junior resident was female, the attending was female and I was female. We talked about shoes and Chanel suits during the case. I tied tons of knots and helped the junior resident close the incision. It was heaven. I found out that I loved Trauma and I couldn't wait to be on call every third day. I had the time of my life and I loved everything about surgery.
My next month was spent on ENT and then on Cardio-thoracic and Vascular Surgery. I scrubbed every case that was assigned to me and many cases that were assigned to some of my colleagues. I became hooked on Vascular Surgery during that rotation. I loved the detective atmosphere on Vascular and loved taking care of the patients. My chief resident on Vascular taught me some great pearls about making sure that even with an amputation, fashioning a well-constructed stump can make the difference between ambulating and not ambulating for the patient. It was great stuff.
After Surgery, I rotated through OB-Gyn. I hated everything about this specialty. This rotation became my only High Pass during third year. I just couldn't get into delivering babies and I wasn't thrilled with tubal ligations. I wasn't thrilled with spending too much time in the clinics and offices. The one bright spot was the Gyn surgeries which I excelled at. I learned the surgical anatomy like a sponge but I knew that this was not going to be the specialty for me.
I finished up on Medicine and Neurology. This would be my final sixteen weeks of third year. I was fortunate to have medicine last because this made study for USMLE Step II a snap. I totally enjoyed Medicine and Neurology but my heart was back in surgery. All of my Pathology experience really paid off because I aced these rotations and moved onto fourth year.
My faculty adviser was chairman of surgery and helped pave the way for my entry into this specialty. I was also co-president of the Surgical Society during my fourth year which also helped. My USMLE scores were good so this helped too. I had some awesome interviews and I landed at a great residency program. My experiences began there and they keep on.
As I continue to write, I will be posting more of my experiences.
Part 2 Why I chose Surgery.
As I moved through medical school, I knew that any specialty that I would enter had to have the following aspects:
Ability to have long-term relationships with patients
Ability to see every type of patient under a variety of circumstances
Practice in office, clinic, hospital, intensive care, operating room and emergency department.
Ability to handle a wide variety of clinical conditions
Ability to deal with both acute and chronic conditions
Ability to perform many procedures
The only specialty that met all of those requirements for me was Surgery. I also loved the aspect that I had to utilize my knowledge of both medicine and physiology to the surgical patient both preoperative and postoperatively. This was very appealing for me. I also utilize pathology and biochemistry to a great degree especially in my teaching of surgery and surgery practice. Again, this made surgery a very attractive specialty.
I definitely started out in residency with a strong interest in vascular surgery. Not only were the vascular surgical patients among the sickest in the hospital on any given day, I also loved seeing the immediate aspects of my work. Once you increase blood flow to an extremity that had previously been lacking blood flow, you see the immediate effects both good and bad. I also liked becoming very familiar with wound care and the healing of chronic wounds.
I had heard about the "surgical personality" and that some surgeons were very difficult to deal with but that never became a factor in my choice of specialty. I don't care if the devil himself is teaching me if the teaching is good. Fortunately for me, that was rarely the case and my knowledge base expanded exponentially with every year of training. Good teaching is good teaching and good faculty allow you to grow and learn from both them and your mistakes in a constructive manner. I also found that I could profit from the mistakes of others at time too.
The other factor that did not deter me from surgery was the horror stories that I had heard about the residency experience. Yes, sometimes I had to work long hours but those long hours yielded some of the best teaching of my life. Yes, I did miss parties and social events but that happens with any aspect of medicine and comes with the territory. Physicians often work long hours taking care of patients who are sick. If you don't like to take care of sick patients, medicine/surgery is not the career for you.
Finally, I have a very good life. I do something that is very interesting and I give my patients 100% at all times. I have encountered some physicians who were psychotic, neurotic, dishonest, unprofessional, racist, sexist, anti-Semitic and just down right stupid. The interesting thing is that I am none of those things and my life is good. Good will goes out from me to my patients and it come back to me in droves. Yes, I work very hard and under extreme conditions at times but I have been blessed with an even temper and a love of my fellow humans.
If you choose a specialty, choose for what you know that you will enjoy doing in most aspects for the rest of your life. If not, you have many years of misery ahead of you. Conditions of practice will change and your income is largely based, not in how hard you work, but on what third-party payers are willing to pay for your services. If you can't deal with this aspect of your chosen profession, get out as soon as you can.
If you choose a specialty because the rest of your classmates were in awe of you, you are likely going to be very unhappy in that specialty. Specialty choice is personal and your classmates will not be entering residency or practice with you. You, and not your classmates, will be the person at 0400h who is admitting that patient with the chronic condition, thousands of medications and multiple needs. You have to love that aspect of medicine/surgery as much as you love the other aspects of medicine/surgery.
Finally, you have to be a ethical and honest person. Showing up at the church door every Sunday does not make you a moral person if you know that deep inside yourself, you couldn't be honest with yourself, your patients or your colleagues. You may not "like" everyone that you work with or work on but you have to have respect for them and give them your best. In short, you can't be having a "bad day" unless you are on vacation. If you are prone to allowing external influences to influence you internally, you are going to have a difficult time medicine/surgery.
Especially with surgery, you will find yourself multi-tasking, juggling six or seven balls at once, shifting up and shifting back on a daily basis. That's the nature of the work and the challenge of the work. If you can't do this, surgery is going to be tough for you on a regular basis. In short, I have never had a day that was strictly "routine" unless I was just teaching for the entire day.
Finally, take some time and get to know yourself and your career needs because after all, this is YOUR career. Your parents, your significant other, your classmates or anyone outside of yourself, can't make this decision for you. You have to know your competitiveness for certain specialties (forget derm if you struggled with every aspect of medical school including boards) and you have to have a good idea of how competitive you are for programs within that specialty.
Also, remember that while residency is when you will hone your skills, it is a short period out of the length of time that you will actually practice those skills. Again, I heard that surgical internship was the worst time on earth but I actually enjoyed my experiences during internship. I heard that surgical residency was the worse time on earth but it wasn't. No residency program is going to be perfect but unless you encounter dishonest or illegal activity, you can live with residency. The clock is always ticking and time passes (quickly in most cases).
Residency requires hard work and hard study. In my case, during my first two years of residency, I studied far more than at any point in medical school in addition to getting my work done. At times, I was "bone tired" but I made myself read and study (minimally for 30 minutes daily). No, I didn't get to the gym as often as I would have liked and I didn't hang out late at night (outside the hospital) but I did live pretty well and my significant other saw as much of me as he could stand anyway.
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