The rotation all PA and Medical students fear the most, the one that intimidates us all. I am not going to lie, I felt the same way before my first day in General Surgery. I remember emailing my preceptor and the first thing he said was
“Review Hernia Repair for Monday.” I freaked out, what am I suppose to know for my first day? What is he going to expect from me? He must be hard if he’s already telling me to study without even starting. I told myself this was going to be a challenging one and I was ready for it after completing Psychiatry. I was ready to see patients and see what real medicine was like. Little did I know General Surgery was going to make such an impact on me as a future PA. The Operating room turned out to be my favorite spot of the entire hospital and here is why.
“Alright, I’m Done, it’s all yours from here"
My general surgery rotation turned out to be a small trauma rotation as well. My preceptor was a physician who retired from the Navy and he was also trained in trauma surgery. We worked in a Hospital in Pensacola, FL. He had won “ The Best Preceptor of the Year in 2018” and as the weeks passed by, it all started to make sense why. This was not the best part, my favorite part of it was he did not have his own Physician Assistant. So, guess what my role was the entire time? I was basically his first assist in every case, and to me this was an indescribable experience. He taught me so much about the operating room, he was super patient with me as a student, he allowed me to do so many things on my own, and after the first case, I was the one closing up all the patients. I even got to close up a patient’s chest after assisting on an esophagotomy with a cardiothoracic surgeon and my preceptor. The amount of adrenaline, excitement, and happiness overflowing my body every time we were in the operating room is something I will never forget.
Growth begins at the end of your comfort Zone
This could not be truer during General Surgery. It is very intimating to walk in a room full of surgical personal and you are the only student, you basically know nothing. Just remember we were all there, take a deep breath and set your pride aside. Being uncomfortable and not knowing everything is what will get your far in this rotation. Be okay with being put on the spot, messing up with the sterile field ( which honestly happens more than you want it to), be okay with somebody screaming at you for doing the wrong thing, be okay with saying the wrong anatomy structure when you are pimped. Being out of your comfort zone will help you learn more than you think. Many times, you have to be the weird student knocking on the door asking somebody to open the locker room, or simply asking where that one case you are supposed to be in is at? Or simply realizing you washed your hands and you are all sterile, but your goggles are not on, it happens. Being in the Operating room is such a different environment than what we are all used to. It takes time to familiarize yourself with the space, the procedures, the personal, and even what everything means, so be patient with yourself. Be cautious how you react to others and always be professional even if they are not being nice to you.
If you want it, go after it
Being timid won’t get you very far in the OR. The experience you have in the OR all depends on you, how bad do you want to perform an intubation before you assist with that surgery? How helpful are you to the circulating nurses to get those catheters in? How bad do you want to insert the IV? Do you want to be the student holding a retractor the entire case or do you want to get to suture and perform knots? The experiences you gain from this rotation all depends on you, go after everything you want to perform and even more. Nurses, CRNAs, PAs, and Surgeons will get the vibe you give. They will love to teach you, show you, and help you perform many things if you are motivated, asking questions, and you show how bad you want it.
Know your anatomy, review the cases
It’s crazy how much Anatomy comes back to hunt you during this rotation. I remember thinking to myself “Crap I haven’t studied this since the first semester of PA school.” This is one of the most important parts of preparing for your surgical rotation, reviewing your anatomy and being prepared for the cases of the day. Make sure you ask what surgeries you will be having the next day and plan ahead. I usually used an anatomy textbook or a YouTube video and I reviewed the blood supply and the nerves. You want to make sure you know the major nerves and blood vessels running around where incisions are made because they will ask you and point it out. One app I found very helpful during this rotation was Touch Surgery. It’s an app that has tons of surgeries step by step and you can watch these videos the day before to familiarize yourself with what you will be doing the following day. Another helpful resource I used was the Surgical Recall book.
Being First Assist
Always introduce yourself to the circulating nurse or whoever is in the operating room. Tell them you are a student and you will be assisting in the surgical case. Get used to writing your name on the board and with getting your own sterile supplies. After a few times of the nurse getting gloves and a gown for you, you will be directed on where all this equipment is kept. The first few days you may find yourself holding the retractor quite a while. However, you will realize you are a huge help to surgeons and the best thing you can do is help them visualize. If you are told to hold the camera, make sure you always keep the image in the center and that its clear. Always make sure the camera is not fogging up, your suction is working properly, and that you are retracting as much as possible. Don’t wait for them to tell you to get suction, asks for laps, or move the camera, stay focused and keep an eye at what the surgeon is trying to do. Many times, I found myself zoning off because I was simply holding instruments and I was daydreaming about something else. When I found myself focused on my role, I was pretty proactive and many times he thanked me for doing things ahead of time.
Snack up, long days are ahead
I learned this the hard way. My first day in the Operating Room, I almost passed out during my first laparoscopic hernia repair. I am not a morning person and I don’t normally eat a breakfast at 6:00 AM, but after this one, I learned my lesson. I felt weak, sweaty, and like my body couldn’t keep up. I quickly told my surgeon I needed to step out and that I was feeling like I was going to pass out. He told me to step out and grab some crackers and water in the break room. I felt weak, especially because this was my first day and my first case. After this, it never happened again until my last week during a big mastectomy case. I packed my over night oats every morning and ate it on my way to the hospital. I had granola bars on my pockets or a banana in my bag. This saved my life because some days we would not get to eat after 7-8 hours of surgery. It’s important that you take little snacks or tell your preceptor if you need some food in your tummy. They will understand you are not used to this lifestyle because to be honest they can go hours and hours without eating and if you don’t say anything, they won’t know.
Preparing for the EOR exam
This EOR is focused on diagnosis and not surgical procedures. Make sure you study the same way you have been studying for your other rotations. One thing you will want to focus on during your studying is the GI section. This EOR contains a heavy portion on GI material. What I did to prepare was reading all of the PANCE Pearls GI section, I studied about 200 questions in ROSH just in GI and then reviewed all of the other topics in the blue print. Important things to make sure you study are hernias and burns, you will definitely get some questions on this.
Please let me know if you guys have any questions, hope this helps you all prepare for your General Surgery Rotation and gives you some insight as to what to expect!
POST EXAM CELEBRATION: NASHVILLE
