Medical

How My Research Degree Taught Me I’m Not a Surgeon

Recognizing the connection between lab work and surgery
What surprised me the most during my medical school journey was that it was primarily lab work, not my surgery rotation, that taught me I was not a surgeon. The type of experience my lab work entailed had absolutely nothing to do with surgery or clinical medicine, so it was a peculiar and fortuitous realization. I do not believe when entering medical school that I had ever thought about doing research, but our program strongly advocated it. I met with various advisors in first year and decided I was going to transition into the combined PhD program.
I knew I had wanted to help the medical/scientific community in the best way possible, and I felt that driving the field forward through research was a great way to do that. I wanted to make a tangible difference in the world. I wanted to have an impact. I also sought to be as saturated and challenged by my workload as possible. I had the philosophy that one could either be comfortable and work below his or her capacity, or be uncomfortable and work above it. I yearned for the latter.
I began working in a tissue engineering lab after my second year of medical school. After passing my PhD confirmation, I slowly started to experience the inconvenient truth that I didn’t enjoy the lab work. I was very impassioned in the beginning, and while I was always interested in learning, it wasn’t the type I felt best fit me.
I began to notice that the only thing that really got me excited at the lab was sitting at my desk reading and writing. I liked analyzing articles, unraveling mechanisms, and arriving at conclusions. Drawing a relationship to medicine, it was similar to the process of diagnosis. I could see that I liked absorbing the ideas within the research field, but not doing the actual lab work itself. As far as I was concerned, after doing one PCR or cytological stain, I had done them all. I had no interest in perfecting lab techniques or maintaining cells in an incubator.
On the door entering my lab we had an illustration of a sign with the slogan “no standing,” the same as for street signs indicating you can’t leave your vehicle parked for any length of time. One of the postdocs used to say, “When I was doing my PhD in the UK, unless we were writing a paper, we weren’t allowed to be at our desks for more than half an hour a day; we had to be in the lab at all times.” Well the same was frustratingly true for my lab, and it was continually inculcated that we needed to constantly be on our feet doing experiments and getting results.
It occurred to me that my antipathy for the lab grew not because it was in any way a negative environment, but because the environment forced me to be someone I wasn’t. There was a guy in my lab who loved the practical work. He enjoyed perfecting his techniques while listening to music. On occasion I would discuss articles with him, and I noticed that he would only ever talk about methods (i.e., “there was this group that refluxed a, b and c for 72 hours in an atmosphere of 50% CO2…”). Meanwhile, I didn’t care about any of that. I only ever read the discussion/conclusion sections and only cared about assembling mechanisms (i.e., “X binds to Y; Y inhibits Z; done”).
While my colleague loved the actual, physical, practical lab work and frequently gravitated toward discussing methods and materials from the articles he read, I preferred to sit at my desk reading and writing and was only interested in the mechanisms elucidated by the articles. At the time, my colleague and I both aspired to go into surgical fields. One day it was unequivocal to me, and I said to him: “I’m not a surgeon. You, however, definitely are. I’m a physician. Or a GP. I’m not sure. But I’m definitely not a surgeon.”
I reflect on that as having been one of the biggest pieces of insight I gained from the research process. And when I eventually undertook my surgery rotation, I could see that surgeons loved the practical work. They loved being in the theatre. They loved working with their hands. They loved being able to fix something on the spot and institute a tangible, concrete impact then and there. I preferred to sit in the theatre staff lounge and read my USMLE books. Essentially, I drew a parallel between the lab and the operating theatre. Both were mechanical. Both were realms of significant hands-on skill. If one enjoys the physical process of working in the lab, then there is an increased probability he or she will enjoy working in the surgical theatre.
Bear in mind this opinion cannot serve in any way, shape or form as an overarching generalization, and there are always exceptions, but it can be said that if a student is ignited and impassioned by the process of lab work, then he or she should consider whether a career in surgery is something that might interest him or her. And similarly, if a student abhors working in the lab, one should reflect on whether a non-surgical pathway is a good fit. On my rotations, I noticed that what excited me most was assembling elements of a patient’s history and exam and arriving at a diagnosis. This was no different than the process of piecing together mechanisms from the discussion sections of articles.
Allow your clerkship experiences to guide your choice of a medical field
I was like any typical medical student entering first year. I was hungry to learn, excited to make new friends, and eager to create new experiences. I didn’t know why my initial interest was surgery. It just seemed exciting, I suppose. Perhaps my parents would have wanted that for me. Maybe surgery sounded prestigious. Maybe it was based on the fun ideas I got from TV shows, movies and books that surgery is what true medicine is about.
It is inevitable that people in any first-year class will already have firm resolve to pursue something hyper-specific. Such as the guy who is 110% sure he’s going into pediatric gastrointestinal oncology, or the girl who, on day one, wants to start her fellowship in orthopedic surgery with specialization in ACL repair. In contrast, there are always students who have no clue what they want to go into early on in medical school. This uncertainty is wise, or lucky, or both.
Despite what impassioned interests one has as a student, he or she will have many experiences and grow a lot through medical school, so keeping an open mind is paramount. At the minimum, one should aim to at least have completed the core clerkships during the clinical years before thinking definitively about any field. I was naïve. I had conviction from day one that I was certainly going to do surgery. The initial interest in surgery wasn’t what was naïve. That was completely irrelevant and could have just as easily been dermatology. What was naïve was the belief that I could have possibly known so early what field I dovetailed with.
Further, it is not uncommon that a preconceived notion of what one wants to pursue is met with subsequent experiences that conveniently reinforce that interest. In other words, if one enters medical school ardently aspiring to be a heart surgeon, suddenly the two weeks spent in the OR during first year observing valve replacements enthusiastically reaffirm that interest. One might be thinking, “This is awesome. This is definitely my calling as I’ve known all along.”
The error here is choosing the trajectory without any real experience or exposure, and then convincing oneself that subsequent experiences confirm the initial trajectory was correct. It’s like drawing a best-fit line without the data points, and then adding them later instead. The reason this is an error is because many initial experiences are going to carry an excitement factor and will be interesting or galvanizing to some degree, so no matter what the experience actually is, it carries the potential to appear substantiating.
It is generally an exception, rather than a rule, if one has a preliminary interest that remains fixed throughout medical school. This is because the very nature of undergoing rotations and developing perspective heralds new ideas and interests. The experiences one has should be what guide his or her choice of a medical field. The latter should not be made prior to the clerkship experiences. It is okay to be contemplative while on rotations, but it is prudent to avoid saying, “I’m going into plastics” when you haven’t even completed clerkships such as pediatrics, OB/GYN, or psychiatry yet, just to name a few. It really is the case that rotations you’re less excited for may turn out to be your best learning experiences, and even the most fun.
Often times one’s lack of interest in a field is because he or she doesn’t know what it actually entails yet. As I said, I had made the fledgling decision that I wanted to go into surgery before I had even entered medical school. However I knew by the end of fourth year that I was certainly a ‘non-surgeon’ type. If one’s decision of a medical field were converted to flowchart form, surgery vs non-surgery is probably one of the most upstream choices one needs to make.
I never would have anticipated that my experience doing lab work, which was supposed to compliment my initial interest in surgery, would have given me such valuable insights into figuring out that it actually wasn’t for me. My main driving point for this article is to imbue the importance of staying open as long as possible and using one’s diversity of clerkship experiences to make a well-reflected and reasoned approach to choosing a medical field. No matter what you choose to pursue as a doctor, let it be something guided by medical school experiences and the unique perspectives you’ve developed along the way.

M
Dr. Michael D Mehlman lives in Osaka, Japan and is an Australian medical graduate. During medical school, he was an author and editor for First Aid for the USMLE Step 1, USMLE Rx Step 1 Qmax, and First Aid Express. He is director of USMLE services at Residents Medical Group. His current passions are... Dr. Michael D Mehlman lives in Osaka, Japan and is an Australian medical graduate. During medical school, he was an author and editor for First Aid fo...