Exposure to new techniques or treatment strategies – how did that go?

During this rotation, I had the opportunity to spend two weeks in general surgery, one week in urology, and one week in neurosurgery. Over this four-week course, I scrubbed into a multitude of cases, some during which I was able to first assist. These cases included excisional breast biopsies, lumpectomies with sentinel node biopsies, bilateral mastectomies with sentinel node biopsies, colonoscopies and flexible sigmoidoscopies which were more observational, fistulotomies, hemorrhoidectomies with/without rectal polyp removal, robotic video-assisted thoracoscopic surgeries for segmentectomies or lobectomies, laparoscopic appendectomies, laparoscopic cholecystectomies, thyroidectomies, an exploratory laparotomy, transurethral resections of the prostate, transurethral resections of bladder tumors, prostate biopsies, cystoscopies, ureteroscopies, ureterolithotripsies, ureteral stent insertions, changes, and removals, a bilateral varicocelectomy of the spermatic cord, a bilateral vasectomy, urolifts, a circumcision where I was able to cut for the very first time, an inflatable penile prosthesis for a patient with Peyronie disease, and a T2 laminectomy with T1-T3 spinal fusion and T8-T-9 laminectomy with T6-T11 spinal fusion for a patient with primary cancer of unknown origin that had metastasized to the spine. During this time, I was also able to insert multiple foley catheters both in the OR and in the ED as well as irrigate and remove them, suture port holes following laparoscopic procedures, suture other incisions, administer spinal blocks, insert, flush, and remove NG tubes, and learn about robotic cases from a PA who is specialized in robotics – something I did not know PAs could specialize in. On days where I was first assist for the entire day, I was also tasked with transporting the patient to PACU and signing out to the PACU nurse, providing the discharge plans and any prescriptions or instructions for the patient upon discharge, which is something I had observed residents do for majority of the time and a responsibility I learned to become more comfortable with. I feel very fortunate to have had such broad exposure to many different surgical cases, and while extremely demanding and intense, I will always appreciate and never forget the experiences I’ve gained from this rotation.

Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them.

This rotation was the first rotation during which I wrote and submitted SOAP notes. Although given the option to write and submit H&Ps, I figured it made more sense during a surgical rotation to get out of my comfort zone and write more focused SOAP notes. During my first two weeks in general surgery, I initially interviewed patients more in-depth and then pre-rounded on them each morning shortly before presenting them during rounds. As such, I composed SOAP notes to communicate any overnight events, significant lab findings, drain or tube I&Os and/or removals, or other changes that have occurred since the day prior. This was challenging in that I was tasked in summarizing the progress note in merely a matter of minutes to a team, which consisted of the chief resident, two PAs who were my preceptors, five residents, and one medical student – a task I found daunting in that they were many different members of the team each with their own preference/feedback for how presentations should be done. Nevertheless, being on the colorectal team, I learned the particular emphasis of noting whether the patient was tolerating their diet or receiving IV fluids, whether their pain was controlled, whether they were passing flatus, whether they were having bowel movements, whether they were ambulating, and whether they were using their incentive spirometer, as such progress points them toward the direction of being discharged. Additionally, during my time in general surgery, I took 24 hour call, which was challenging in that there was no time for sleep, as after an full day of surgical cases and helping out with ED consults, I scrubbed into a five hour long exploratory laparotomy ending at 2:30am only to be up for rounds at 5:45am. Operating throughout the rotation without much rest or time to eat was definitely difficult to manage, though became something I was more deliberate about toward the end of the rotation. Moreover, on top of balancing the demands of the rotation itself, time management with respect to outside workload was really difficult, as I needed to present an H&P and topic presentation during general surgery to my preceptors and two H&Ps during my one-week course in urology as well as my SOAP notes, pharm cards, and journal article summary for my site visits. The constant need to stay on top of everything for 16+ hours of the day was tough.

What one thing would you want the preceptor or other colleagues to notice about your work in this rotation?

I find that it is easy to be intimidated in a surgery rotation, especially when working with a team full of different personalities and expectations, different surgeons, different surgical techs, different nurses, and different anesthesiologists. It is also intimidating even before starting the actual rotation, as it is just a known fact that the rotation is at least one of the hardest rotations, if not the hardest rotation. Despite having this preconceived notion in mind and then working through it, one thing I would want my preceptor and other colleagues to notice about my work is that I gave my best effort every day and that I maximized my time to learn and gain as much experience as I could. I was actually very happy to find out that the chief resident during my week in urology submitted positive feedback about my work, in which he stated that I will make a meaningful difference in whatever specialty I chose because that is the most important thing I want to be remembered for, not just during my rotations, but in life.

What did you learn about yourself during this 4-week rotation?

During this rotation, I learned that I am capable of so much more than I thought – that there is a whole lot more potential to be unlocked so long as I stay open to the possibilities of what I can do and what I can learn. In addition, I learned the value of working hard regardless of who may or may not be watching because one day, it will pay off. Even in a matter of just a few days, it is possible to leave a meaningful, lasting impression on people, whether that be on patients or on colleagues. Some will appreciate your work more than others, and that is something you need to be okay with, especially when you know you are doing your best each time. Lastly, I learned the importance of being more deliberate in making sure I get enough rest. It is personally easy for me to neglect my own needs, be it for sleep, rest, food, or hydration, because of the pressure, which is sometimes self-imposed, to do as much as I can. However, I have learned, and it has been brought to my attention, to do a better job of taking care of myself when balancing the demands of this rotation. Not only can I take better care of patients, but I can also take better care of myself.