Medical students: how to survive a surgical attachment

Right, you little munchkins, I’ve had enough of your disinterested and sullen faces slumped over coffee at tutorials, my clinic, theatre exit rooms, etc. If you want to get anything out of general surgery, by which I mean get anything out of us, you have to engage our interest.

I can’t say this to you in the hospital as I would be done for bullying or some other crap (like my colleague in ortho, accused of being a chauvinist for some minor joke in a lecture) so I’m not going to hold back here.

The first thing we will ask you is if you want to be a surgeon, now, we know you don’t, if you did you would have already told us. Surgical med students are practically jizzing in their pants to speak to us and come to theatre.

When we ask you though, don’t say “I hate surgery”, “anything but surgery”, “I can’t tie my shoe laces and am very clumsy”. Even if you want to be a palliative care physician or a telemedicine community psychiatrist somehow or other put a spin on why surgery is interesting and relevant to you. The fact that the university is going to give you 2 degrees, one of which is a bachelor of surgery seems lost on you all and I think you should just be given an MB not MBChB.. Sorry I am off on a pet rant of mine.

Somehow or other fake some enthusiasm for surgery. At some point in your life you may be required to lance an abscess or amputate a limb to save a life. Who knows how or what or why, but you have the letters after and the title before to suggest that you have some basic competence at this sort of thing.

Pre theatre dinner.

You must, must, must have a pre theatre dinner. By which I mean get your tea in early and then open some books. Anatomy textbook, followed by surgical text books (note plural), followed by YouTube or websurg to watch a heavily edited operation. Then if you are genuinely interested you can look at some guidelines for management.

Anatomy obsessives

We are crazy about anatomy. DO NOT say to me that you can’t remember any anatomy because it was a long time ago. It was not a long time ago, 20 years ago is a long time, 2012 was very recently. You don’t remember it because it was badly taught, you weren’t interested, it meant nothing to you at the time and you didn’t bother learning it.

The anaesthetist

The anaesthetists are not better teachers, they don’t like you more than me, they are so bored that they teach you. They have done their bit, now they’re cruising at 32000ft and want a distraction, meanwhile I’m in an abdomen which has been unzipped for the fifth time, dealing with adhesions from hell and an unexpected amount of bleeding..I’m not talking to you because I am busy. So don’t put it in your feedback form that we didn’t speak to you much during operations!

We are predictable creatures

I ask the same stuff over and over and much like the professor of infectious diseases asks you all what bugs cause pneumonia and where the likely sources of E. coli bacteraemia are, my colleagues and I are similarly predictable.

Causes of pancreatitis, symptoms of colonic and rectal cancer, gall stone disease, causes of jaundice, small bowel obstruction, stomas… All of which is very standard general surgical fare, we aren’t looking for anything weird in the differential diagnosis of a profusely vomiting patient, I want the common stuff.

Little black book

In the olden days, before Tinder and mobile phones and Facebook, people kept their friends contact details in an address book. “A little black book” usually contained numbers of members of the opposite sex and was closely guarded. You need to get a little book, not a bit of paper, and you are going to write down all the things you encounter in a day that you don’t know. Take an ERCP- today on the round we spoke to a patient who was going for one- then we moved on to the next patient. I asked the four students what an ERCP was as we left the bay, none of them knew. Nobody had asked or written it down to ask later. You must do this, write it in your book and consolidate your learning at home with a textbook afterwards. This is the whole point of these (stupid) self directed teaching methods that they are so keen on these days. It doesn’t work if you are not paying attention to what is going on.

Try and enjoy your time with us, if you give it some effort we will too. Read the books, some students last year told me that they don’t have a surgical textbook as they don’t need one; you do. You must have one and you need to read it throughout the attachment.

We love having motivated and interested students around. Ask lots of questions, ask to scrub in as much as you can, follow the people that seem to like teaching you and are good at it. Stay away from those who ignore you or are mean. If you are able and keen, do a night shift or a weekend shift, you will get one to one teaching and get to do a lot more in theatre as we need the extra pair of hands.


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