Today was my last day of surgery, meaning I've now completed the two long 3 month cores, two of the short 6 week cores, and only have one 6 week core (ob/gyn) left! It really is amazing how quickly time goes by in med school. I'm not at all looking forward to 6 weeks in NY, particularly in Flushing, and particularly doing OB, but I know that shortly, it will be over too. And then, it's only another few short months of electives before med school is over.
For those interested, here is my review of the St. Agnes surgery core:
Daily Schedule: I typically arrived sometime between 5:15 and 5:45, depending on the day. On Mondays and Thursdays, you get in closer to 5:45, because there is no lecture and rounds begin at 6:30. On Tu, Wed, and Fri, there is a 7:00 lecture, so rounds start at 6:00am (tuesday is M&M, wed is resident lecture, and friday is surg grand rounds). About twice a week, there is a student lecture which typically follows one of the other morning lectures. These lectures take priority over anything else.
After lecture, you usually go to the OR for the day, depending on how many cases there are. There are days that you don't leave the OR until afternoon rounds (or you may miss rounds some days), and others that there are only 1 or 2 cases for the whole team, so you may not be in the OR at all. OR takes priority over everything else but lecture. So, if you're in the OR, you don't have to see consults or deal with floor scut, which is nice. If you're not in the OR, you may be able to do some procedures around the hospital (sutures, I&D, pull drains, etc), you'll likely be asked to see a consult or two, and there is also actually plenty of free time to go to the library and study! You also have to make sure and keep up with what's going on with your assigned patients (depending on the size of the list for the day, you'll probably have around 5 patients).
Surgery Teams: You spend one month each on blue, red, and gold team. Blue team is primarily bariatric and some general. You definitely get plenty laparascopic experience on this team, and the bariatric surgeons are some of the best you'll find. However, the cases can get a little old after a while, and you'll probably be ready to move on by the end. This is also the thoracic team, but there is really only one thoracic surgeon (the program director). When you have surgeries with him, you better know about your patient! Finally, there is a pretty renowned surgical oncologist on this team who does the HIPEC procedure, which you'll likely see at least once. The surgeries can be pretty neat, but there is unfortunately no open heart here. This team usually gets out the earliest at the end of the day. Depending on who's on your team and what's going on, you'll probably be out between 4:30 - 6:00pm.
Gold team is primarily general surgery. By the end, you'll probably feel like you could do a lap cholecystectomy, appendectomy, and cyst excisions on your own (although you never will, of course). There is also a decent amount of open surgery, which can be pretty cool to see. Lots of cancer colon resections. Unfortunately, you also have to go to clinic twice a week (half day each) on gold service. It's pretty standard clinic type stuff...some pre and post op underserved population patients.
Red team is primarily vascular surgery, with some plastic, urology, and hand cases. You will primarily work with three surgeons, all with very interesting personalities. They are mostly nice to students, very smart, and spend a decent amount of time teaching, but you are likely to hear some choice words in the OR, and may see some instruments thrown. These are the longest cases, it's definitely the most demanding team, and you'll get out the latest (sometimes after 7pm). The plastic surgeons are amongst the most polite in the hospital, but you don't get to do much in those surgeries (they suture themselves).
In the OR: In general, you don't really get to do all that much in the OR, because of the large number of resident, who want to do most everything. You will, however, get in plenty of suture time...as long as you want to and are not an idiot. Mostly, you spend time retracting, suctioning, watching, and often times closing at the end (the longer you're there and the more interested you appear, the more you do). You may occasionally get to use the bovie, cut, tie, or staple something, but it's pretty rare. You will probably never touch a laparascopic tool, other than the camera (which you drive pretty frequently). Fortunately, you scrub into just about every case, so you're always somewhat involved. Teaching in the OR is very attending dependent. Some will pimp the hell out of you (rare), some teach, some don't acknowledge you at all (also rare). You may get yelled at infrequently, but don't take it personally, especially on red team. You also help get the patient ready, including moving around the bed, draping, putting in a foley, etc. At the end of a surgery, you typically write the post-op note. A few hours later, you should find the patient and write a night of service note. Both of these are very fast and easy to do.
Call: Fortunately, this rotation has a pretty light call schedule. Depending on how many people are in the rotation with you, you are on short call every 4-5 days, and long call every 12-15 (most likely 4, and 12). On short call, you stay later than the rest of your team to help finish up whatever is going on. This may mean taking a later surgery, seeing an extra consult, or something similar. You usually are out around an hour or two after everyone else, but it could be more or less (rarely more). Long call is overnight; you leave the next morning after rounds. If there is morning lecture, you unfortunately have to stay for that too, but you don't have to stay for afternoon lecture. You do not have any OR or floor responsibility (other than rounds) on post call days. If you're short call on the weekends, you're really only there to round and should be out before noon (sometimes out before 9am). Long call on weekends is still around 25 hours.
Residents/ Staff: It's really hit or miss, as with most places. There are excellent residents, and there are some not-so-excellent residents. The prelims are mostly foreign, and the categoricals (at least the new ones) are almost all US grads. Unfortunately, the dept chair does not particularly care for caribbean grads, although all the students are from the caribbean! The attendings are much the same...some fantastic, some not so much. In general though, the staff is good. There is plenty to learn, and plenty people willing to teach. The scut work is present (as it is anywhere), but it's really not bad. I was scutted much less in surgery here than I was in IM. There is a good chance I'll return here for SICU rotation or a surgical sub-I.
I realize this is a lot, but it should cover just about everything. Every surgical rotation is different, but this should give you some idea of what to expect. It is tiring, and I'm glad to be done, but it's not as killer as some say...certainly not as bad as it was in years past before the 80 hour work week! As I said, there is plenty time to study during the day too.
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