Medical

To Cut is to Cure: A Review of Clerkship #3, Surgery

Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
This month’s post comes at the halfway point of my third year; I have now done three of the six clerkships that comprise this year. Every medical school structures the clinical years a little bit differently; the rotations I am doing are considered core rotations by my school, and tend to be fairly standard. Regardless of location, nearly every student does at least one surgical rotation, and that is what my last eight weeks have been: four weeks of general surgery, two weeks of trauma surgery, and two weeks of a subspecialty (mine was pediatric surgery).
This rotation was my busiest so far, and the hours for both surgeons and students rotating through surgery are notoriously long. I realized early on, however, that this is not simply by convention or desire. Instead, it is because of the diverse nature of tasks that surgeons must accomplish. When most doctors arrive at the hospital to begin seeing patients, surgeons are already in the operating room, so surgeons must arrive early to see their patients before operating. Further, there is some control over when surgeries are scheduled, but surgery itself can be somewhat unpredictable. If an operation takes twice as long as expected, one cannot simply clock out, go home, and finish tomorrow. This combination of factors leads to the long hours of surgery.
Related to this, one of my major observations during this rotation is this: Surgeons do a lot more than surgery. Surgeons are primarily concerned with what happens in the operating room, and this tends to be how most people imagine them. Yet they are responsible for managing hospitalized patients just like hospitalists. These tend to be patients who were hospitalized for something else and develop a surgical problem, patients who are suspected at admission to have a surgical problem, or patients who recently had surgery and need to stay for observation. Surgeons might function as internists, consultants, or even subspecialists at times, though their concentration is still on surgical problems. Most have a clinic as well, in which they evaluate patients for surgery and see them post-operatively; this is another aspect of a surgeon’s practice that is not often considered or highlighted.
Despite this, the focus of a surgeon is still on surgery, the physical act of performing procedures, usually in the operating room under general anesthesia. Other specialties do surgery (OB/GYNs, interventional radiologists, and some subsets of internal medicine) but most of the operating done in medicine is done by doctors trained in general surgery or one of its subspecialties. It is this component that draws students to surgery; the experience of entering the operating room, scrubbing in, and going to work cutting and sewing and healing is incredibly unique, and for many, a magical experience.
The opportunity to work with one’s hands and make tangible fixes to patients’ problems cannot be overstated. This is often discussed by surgeons on why they like what they do, and it truly is a major component of the specialty. Other doctors may do something similar: providing a medication that works quickly, for example, or correcting electrolytes to provide instant relief. Even so, few things compare to the ability to locate precisely the source of a person’s ailments and literally remove it, permanently solving the problem. This is a compelling reason to choose surgery – not waiting around to see if something gets better, not managing problems from a distance over a long course of time, but addressing them directly.
Another significant aspect of general surgery is the opportunity to care for very sick patients. Many fields deal with patients who are not critically ill, which is of course necessary and valuable – “an ounce of prevention is worth a pound of cure” is highly relevant to the healthcare system. Many surgeons, though, would rather treat acutely ill patients, and many find it deeply satisfying to take care of such people and often restore them to health. This too is desperately needed in our healthcare system, and students who see themselves more within this category may be inclined towards a surgical field.
Like other fields, surgery requires critical thinking, capacity to solve problems, creativity, and efficient communication skills. Aside from these abilities, surgery requires a different set of skills, more basic things: being able to stand on your feet for long hours, being comfortable with moving quickly from one thing to the next, being able to juggle many activities at once, and exhibiting calmness under pressure.
I was particularly struck by the diversity of problems general surgeons manage; there is a wide variety of procedures in general surgery, and the five-year residency offers training and experience in a broad set of skills. While many are drawn to surgery because of this breadth, there are extensive opportunities to pursue fellowships and become an expert in a given subset of surgery. Subspecialties include: Bariatric, Breast, Colorectal, Surgical Oncology, Hand, Oral & Maxillofacial, Pediatric, Plastics, Surgical Critical Care, Thoracic, Transplant, and Vascular. There are also integrated programs available for many of these, including Plastics, Thoracic, and Vascular. Surgical specialties that are not pursued via the General Surgery route but are worth mentioning here as their own specialties include Neurosurgery, Orthopedic Surgery, Otolaryngology, Ophthalmology, and Urology. Many other specialties have a component that is procedural, but these are the ones in which operating is central, and are likely to be on the list for a student wanting to pursue surgery.
I learned much on this rotation, and had the opportunity to work with some amazing patients. I’ll be using some time this break to reflect on some of the most significant experiences from this rotation and this completed half of the year, which are likely to show up in future column posts, so stay tuned. Warm wishes for the holidays and enjoy whatever break you may get!
About the Author
Brent Schnipke is a third year medical student at Wright State University Boonshoft School of Medicine in Beavercreek, OH. He is a graduate of Mount Vernon Nazarene University with a degree in Biology. His interests include medical education, writing, medical humanities, and bioethics. Brent is also active on social media and can be reached on Twitter @brentschnipke.

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Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshoft School of Medicine. His professional interests include medical humanities, mental health, and medical education. Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshof...