A long time in the making, we are ready to discuss Ryan’s surgical rotation. The second-to-last rotation of Ryan’s third-year, surgery encompasses the epitome of the medical school stereotype – incredibly long hours, never enough sleep, and exposure to a unique medical experience. Students get to work at the bottom of the totem pole in one of the most stressful and fast-paced quarters of the hospital.
The eight-week rotation is broken into two four-week sub-rotations. Ryan chose Surgical Oncology (Surg Onc), because of his related interest in Radiation Oncology (Rad Onc), and Burns, because his school has a well-known burn center.
On a typical day in Surg Onc, Ryan woke up at 3:45 AM to arrive at school by 4:30 AM and pre-round with his postop and consult patients. This included reviewing the chart for overnight events, visiting the patient, and completing a physical exam. For each patient, of which there were anywhere from 1 to 4, Ryan filled in a custom-made rounding template sheet that documented vitals, morning labs, and overnight events. Ryan used the template to present his patient to his residents during rounds at 6 AM.
Days were split between the operating room (OR) and outpatient clinic. Ryan and the other medical student on the rotation alternated days spent in the OR in an attempt to balance exposure to various procedures. There were two distinct types of surgeries they participated in during this month: abdominal cancers (stomach, small intestine, pancreas, liver…etc.) and breast cancer.
Depending on which attendings and residents were in each procedure, the responsibility of the medical student varied from being “first assist” on breast surgeries to watching 6-hour long “Whipple procedures” from a distance. Attendings often took advantage of spare moments in the OR to conduct pop quizzes on anatomy and cancer biology as a way to assess students’ preparation for the day’s cases.
Clinic days were faster paced and consisted of seeing patients for brief visits to make sure their recovery from surgery was progressing appropriately. Although there was less time for teaching and assessments in clinic, Ryan was exposed to a greater variety of patients.
Ryan would typically make it home between 4 PM on good days or after 7 PM on the longest days. Each evening, Ryan read over his cases for tomorrow and reviewed the procedures he witnessed that day. Students are expected to answer questions on the spot during rounds, and these few hours before bed are the only time they have to learn. Ryan vacillated between going to bed between 8:30 and 10 PM.
Ryan encountered a challenging dynamic among his team with an overbearing chief resident that showed little interest in helping the medical students transition into a stressful rotation and had a tendency to shame the students for not knowing more. Gratefully, the chief resident went on vacation for one of the four weeks, putting the third-year resident in charge. He was someone with a genuine, deep interest in helping students learn, and it was useful for Ryan and his fellow student to receive validation that it was not something with them but the chief resident that made the day-to-day tasks more difficult.
For the most part, Ryan greatly enjoyed the exposure to interesting surgeries and the teaching methods of his attendings on this part of the surgical rotation. He witnessed firsthand the collaboration between the Surg Onc and Rad Onc teams and still feels confident in his decision to pursue the Rad Onc specialty.
Meanwhile, this month coincided with my spiral downward in work satisfaction at my old job. It was difficult maintaining motivation for my own responsibilities, and I sorely missed having Ryan to lean on and receive advice from. As I mentioned, Ryan was aware that I was struggling but simply could not offer much time to help. Thankfully things took a more positive turn for me not too far into his next sub-rotation where our story continues. Stay tuned!