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Third year clerkships part two: Surgery, OB/GYN, & family medicine

Time for third year clerkships part 2!


If you haven’t gone back and read part 1, please go check it out here: (Third year clerkships part one).


We’ll start off with surgery, especially since it tends to cause the most anxiety for students, especially if they aren’t planning on pursuing a surgical residency.


Surgery

Although the surgery clerkship is in it’s own category, the day-to-day schedule is similar to that of internal medicine. There’s a good chance you may have the responsibility of preparing “the list” of the service, whether that’s inputting labs and vital signs or updating with admissions from overnight. You may be required to attend check out from the night residents in the morning, but you will most likely be observing and not required to participate. After that, you can begin your chart review in the same process we described in part one of this series and will likely round with the residents and then with the attending physician. The main difference when it comes to the surgery clerkship is that you will be required to scrub into the OR cases, assist with bedside procedures, and do dressing changes and any other tasks required throughout the day. Surgery is much more hands on and we would encourage you to help the residents as much as possible!


Your presentations will be in the SOAP format that we described in the last post but will likely be more succinct. On the surgery rotation, the most important things are to find out if the patient is ambulating, having bowel movements and urinating while also noting the drains/catheters and their output and checking out the surgical sites. One way to really stand out is to keep track of who needs dressing changes daily and have the supplies at the bedside for morning rounds.


We’ll be honest, it can be challenging to stand out (in a good way!) on your surgery rotation. The culture can often be intimidating and you will likely feel out of place and a nuisance, especially if you are not pursuing a surgical specialty. Many of the tips discussed in our other post remain the same (take ownership of your patients, spend time with your patients, take the initiative, and advance your learning), but there are a few extra steps you can take on a surgery rotation to help out your team.


How can you shine?


Assist with dressing changes, obtain supplies for bedside procedures, grab extra sterile gloves for surgeries, and offer to do anything to make the residents’ lives easier. Again, if your team looks good, you look good! Residents are often overworked, hungry, and exhausted so if you help them out you will likely be a lifesaver to them. And, not to mention, these skills will be very useful for you in your intern year and beyond even if you aren’t doing a surgical residency! Be a team player. Pockets are helpful and if you have culture swabs, 4x4s, and other dressing change supplies on hand, you will be a superstar.


In the OR, you will likely be pimped on anatomical structures, techniques, indications for surgery, etc. Make sure to read up on cases that you will be scrubbed into for that day so you can be prepared. As a medical student, you will likely be asked to retract structures, hold the laparoscopic camera, assist with suturing and closing up, and perform other minor tasks. Before the case starts, you should try to help out as much as you can. Whether that be helping move the patient from the bed to the operating table, preparing the sterile field, reassuring the patient before sedation, or texting the residents when the patient is moving from pre-op to the OR, try to do everything you can to be helpful.


Unfortunately, most medical students will be scolded by the scrub tech and/or circulating OR nurse at least once on their surgery rotation. It happens. Don’t beat yourself up about it because it happens all the time. Most of the time, students get in trouble for breaking sterile field, scrubbing in incorrectly, or touching something they aren’t supposed to. All you can do is apologize, learn from the mistake, and try not to take it too personally.


It can be challenging to stay sane during this rotation and not get burnt out. Just realize that it is temporary, do your best to still participate in things you enjoy to blow off steam, and spend time with friends and family.


General tips: Pack easy, healthy snacks/meals that you can eat on the go. You likely will not have time to stop long for lunch so keeping granola bars, sandwiches, and other easy options in your pocket or nearby will help you to avoid being ~hangry~. Plus, you wouldn’t want to go hypoglycemic in the OR!


Resources for the shelf: Uworld, Dr. Pestana's surgery notes, Case Files.

OB/GYN:

Once again, babies!!!


There will be many overlaps between OB/GYN and surgery, internal medicine, and family medicine. The OB/GYN rotation can be variable based on the way your medical school structures it, but most rotations will consist of L&D, outpatient OB/GYN, inpatient OB/GYN, and possibly antepartum and GYN oncology. You will likely get to spend some time in the OR as well and be a part of C sections, hysterectomies, ovarian cyst removals, etc. In the outpatient clinic, you'll likely be helping with pap smears, speculum exams, and prenatal exams. The tips for the other rotations definitely apply here, but we will provide some additional tips below that are specific to OB/GYN.


Be extra compassionate to your patients because you never know if the pregnancy was originally planned, what their family support is like, and how nervous they may be about this huge change in their lives. Try to provide as much support as you can and offer reassurance if they need it.


Get involved! Even though it’s nerve wracking to deliver your first baby, it’s such an important part of medical school. The residents and/or attending will walk you through the whole process and it’s a surreal experience. Take advantage of it because you might not be able to do it ever again!


Resources for the shelf: Uworld, Case Files, OnlineMedEd.


Family medicine:

The jack of all trades! There are so many possibilities when it comes to family medicine.


Since there is so much variability when in family medicine, medical students’ experiences may be very different. For instance, Wade was in an adult clinic where he did many procedures, started IVs, and had a significant amount of autonomy. In my case, I (Catherine) had a great experience but did not do as many procedures and had less autonomy. Other students will be in a more peds-focused or OBGYN-focused clinic. Certain clinics may focus on certain chronic diseases (diabetes, hypertension, etc.) and others may be more mental-health oriented. Some family medicine docs even do inpatient medicine, colonoscopies, C sections, and so much more! The experience is very dependent on the physician you are working with, location (rural vs. urban) and individual clinic or institution.


Resources for the shelf: Uworld (there’s not a specific Family medicine section, but you can use the ambulatory medicine section or just do a mix of everything), Case Files, AAFP questions, Step up to medicine (especially the ambulatory section).


Don't forget: 3rd year clerkships (especially your core rotations!) are where the majority of your residency application letters will come from. So take them seriously and impress your faculty!


Get geared up for the best years of medical school!


--C&W

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