Tag Archives: Surgery
At this point in the year, most medical students have already started Gross Anatomy and have gotten a feel for many of the resources available to them. A review was previously written that compared some of the more popular anatomy atlases, and only a brief mention has been made on this site so far regarding anatomy flash cards. For many students, the idea of atlas flash cards seems redundant. You should be familiar enough with your study and learning habits to get a feel of this already. However, there are some benefits to this resource which are best shared by people who have already gone through the full experience of medical school.
Regardless of which atlas you have selected, you are most likely going to be bringing it around with you, or using the local library copy. However, this has its limitations. Pulling out a copy of Rohen on a crowded bus can not only be disturbing to those around you, but produce a serious issue of professionalism. Similarly, waiting for a bus or standing around somewhere makes balancing a thick anatomy atlas somewhat annoying. The first strength of Netter’s Anatomy Flashcards (now in their third edition) is their size. Reviewing them is not only easy to manage, but they are also easy to hide.
Chances are, your anatomy class will focus on one particular organ system or anatomic area at a time. The full Netter’s Anatomy Atlas text is 620 pages, which is overkill for your specific study needs in any given week. While it is a great resource, carrying it around along with a syllabus is going to get tiring pretty fast. A better tactic is simply grabbing the color-coded stack of flash cards dedicated to your current area of interest. The latest version already has hole punches, which keeps organization manageable. At some point in med school, most medical students realize the usefulness of portability. Stack a few cards on top of your snack bars, and you’re set for the day.
Purchasing Netter’s anatomy flash cards new grants access to the studentconsult.com online version of this resource from any computer. Even if you forgot your cards at home, you can still review them. This basically creates a second copy of the cards, which you can access indefinitely, even if you want to share the hard copy with a friend. Some will argue that this is especially useful when accessed remotely on a smart phone, but most med students would disagree. The detail of the structures combined with the small font makes for a suboptimal viewing and thus learning experience. This is precisely the reason the iPhone and Android app of any atlas is usually contraindicated.
While most first year resources are rarely used by med students on the wards, anatomy is something that will need to be reviewed for a number of clerkships, including surgery, ob/gyn, neurology, as well as elective rotations in any surgical subspecialty. Again, a full atlas is always best, but not something easily stored in scrubs pockets and referenced between cases in an operating room.
A set of anatomy flash cards can usually be purchased new for $25. Because they tend to be in moderate demand every year, they have a resale value that will allow you to recover the majority of its initial cost. Furthermore, selling your set used does not remove access to studentconsult.com, which means you can continue referencing the electronic version. Even when new versions come out, older sets can usually still be sold. With that in mind, it is perfectly reasonable to purchase the previous version of these flashcards. Human anatomy hasn’t changed too much since 2006.
As a runner up reason not to overlook Netter’s Anatomy Flashcards: They go particularly well with people in the Rohen camp of anatomy atlases, as it offers a little bit of Netter drawings to complement and enhance the Rohen experience, producing the best of both worlds.
To complement the recent release of our book recommendation for Ob/Gyn clerkship and Step 2 review, we offer the below experiences in hopes that rising medical students can learn from past mistakes and successes. Obstetrics and gynecology is usually perceived as one of the more labile rotations you will face in medical school. While there are clear differences between hospitals across the nation, and even great variability between teams within the same hospital, this tends to generally be the case with respect to other rotations.
In distinction to many other clerkships, most medical schools rotate students through a number of different ob/gyn sites and settings, usually highlighting outpatient gynecologic exams, inpatient or surgical gynecology, outpatient obstetrics, and labor and delivery. This generally prohibits cohesive or longitudinal teamwork, and leaves residents and attendings with very little exposure time from which they must draw their evaluations. As such, the first piece of advice is to pre-read before starting obstetrics and gynecology. This is in distinction to other stable rotations where reading can be done along the way. You will get pimped on day 1, and have few days past that to redeem yourself. Come in knowing your basic terminology and abbreviations.
Outpatient ob/gyn clinics are usually mixed. Some will probably be shadowing, while others are primary care based, where focus should be on prevention and good planning. For gynecology, you should know your in-office STD and vaginosis screenings, what to look for on microscopy, and how to treat each. Every exam should have a complete history on sexual partners, obstetrics (G’s and P’s), contraception, pap smears, STDs, vaccinations. If you’re uncomfortable talking about these topics, now is the time to get over it. Be sure to bring your stethoscope.
For obstetrical checkups, you should go in knowing your screening tests, timeline, and the most common reason for first and third trimester bleeding. Presentations should always start with something sounding like “28 year old G3P1011”. G (gravity) stands for the number of total pregnancies. P (parity) has four numbers which correspond to full term pregnancies, pre-term pregnancies, abortions/miscarriages, and live children, in that order. You will be commonly treating bacterial vaginosis and trichamonas with flagyl (metronidazole). You should remember this medication has a disulfiram effect, so it should not be taken with alcohol. Some patients will actually forego treatment until the weekend is over because of this unwanted reaction. Yes, really.
Experiences are usually divided between benign and gynecology-oncology. You should have a pair of gloves and lube packets in your back pocket at all times. Each surgery will start with a pelvic exam on your unconscious unconsenting patient. When the resident lubes up, extend your pointer and middle fingers towards them like a handshake for a “high two” to share their lube. This is how Ob/Gyns bond in the wild, along with matching surgeon caps, black zip-up tops, and playing their favorite game: “find then avoid the ureter.” The pre-op exam is a great opportunity to get your pelvic exam down, so don’t pass it up.
You will most likely need to be able to gown up yourself. If you haven’t had surgery, ask an intern or fellow med student to teach you on the first day of your rotation, regardless of whether you’re starting on something surgical. You should also come into this rotation knowing basic knot tying techniques, regardless of whether you’re going into anything surgical. It’s just a good basic skill to have throughout medical school. If you aren’t familiar with knot tying, a quick search on youtube and spare string or sutures will be helpful. If you have these basic skills down, you will be allowed to do a few things aside from retract. Remember, if you are down below, it is considered “dirty” even though you are in sterile garb. Never move from pelvis to abdomen without changing gloves. Crazy pimp question: most med students are taught in anatomy that nothing runs with the round ligament, so naturally many attendings love asking about it. The correct answer is the Sampson artery.
If you are interested in catching babies, try to take shifts when there are minimal residents, such as nights. If your hospital has private attendings who allow medical students with them, jump at those opportunities. They’re the ones who will let you actually deliver, whereas many of the interns (especially new interns around July) will soak up the opportunities with staff attendings. A lot of labor and delivery is just going into rooms and asking “is there anything I can get you?” and then fetching ginger ale. However you should push into the action when it starts.
The best way to learn how to deliver a baby is to find someone who will let you put your hands on top of theirs for a few deliveries so you get an idea of just how much pressure and movement is needed. Next step up is having your hands under theirs. Once you have a good feel for that, you’re good to deliver with observation. This technique isn’t necessarily offered or known to many residents, so be sure to ask, but it really works well. Be careful when you put on gloves in the room, because it is not uncommon to get surprise-lubed by one of the nurses, whether you wanted it or not (although you almost always want it). If you have the opportunity, try to spend a little time on triage (be sure you know the signs of labor!).
If you have tips or suggestions you would like added to this article, please add them in the comments.
Surgical Recall is one of those third year med student books that can be your secret phone-a-friend ace up your sleeve, and concurrently your downfall. There are a number of books you will encounter throughout medical school where the outcome of that class or clerkship is dependent on how the book is used. Just as you wouldn’t use Netter’s or Rohen’s to replace an anatomy text, Surgical Recall must be used properly.
As the title implies, Surgical Recall is your guide to all things pimping on surgery. Unless surgery is your first rotation, you should already be aware that the pimping starts on the very first day. Accordingly, you should ideally grab a copy of this during the weekend before your surgery clerkship starts and dig in quite a bit by time you hit the first day. This is the book that’s going to help you avoid looking like a total newbie, because common surgical etiquette and culture is not taught in preclinical classes. This is the book that’s going to tell you all the usual abbreviations, the names of all the different scissors you enounter, why you should NEVER touch the mayo tray (and what that is), and all of the common pimp questions you will commonly encounter.
Like other books in the Recall series, Surgical Recall uses a split page question and answer format that quizzes the reader on all the common things seen in surgery. The book does a good job in its use of pictures, especially on sections dedicated to surgical instruments and consumables. This is important as most third year med students don’t know what a JP drain is, what JP stands for, what they look like, and how they are different from other drains. You could responsively google “JP drain” right now, but you won’t know the names of all the other commonly used tools, which is why this book is helpful.
The latest edition (as seen above) has taken on a somewhat retro look. Perhaps market research has shown med students go for books that are already on fire to quell the need to later set them ablaze in frustration, or perhaps this just allows for the subsequent edition to look modernized in comparison. Nonetheless, we can’t judge a book by its cover, else the BRS series of books would have gone extinct long ago. The first section of Surgical Recall is going to touch on the big picture and background of surgery, including abbreviations, surgical signs, syndromes, cutting, suturing, tying, instruments, preoperative requirements, wound care, hemostasis, nutrition, shock, complications, and surgical anatomy pearls. Section II goes over the main general surgery areas, including GI hormones, GI bleeds, hernias, laparoscopy, trauma, burns, bariatric surgery, appendicitis, ostomies, fistulas, IBD, portal hypertension, other hepatobiliary diseases, the breast, endocrine, melanoma, vascular, and intensive care unit knowledge. The third and final section hits the surgical subspecialties, including pediatrics, plastics, hand, otolaryngology, thoracic, cardiovascular, transplant, orthopedics, neurosurgery, and urology. This book is around 800 pages long, and while the question and answer format allows for a faster read, you should generally focus on the general surgery knowledge and the topics that specifically correspond to your surgical service.
Included with this latest version is the promise of free “Mobile Access.” As of now, the jury is still out as to whether this is legitimate, as a number of students have had a hard time actually accessing it through their phones without paying the additional ~$45 app price through Android or Apple. It may be fixed in the future, but don’t purchase this book thinking it will instantly be on your phone.
Surgical Recall can be the downfall for the occasional medical student who believes this is the only book needed during surgery. Indeed it will seem like a cheat sheet, whereby memorizing this book will produce superstar results in the operating room and floors (and it will). However, the NBME Surgery Shelf Exam doesn’t care about the things that make awesome operating room medical students that get all the obscure attending questions. There is no Surgery Shelf question on one-handed ties, no Surgery Shelf question on drain choices, and no Surgery Shelf question on how your attending likes their coffee. Make the distinction: there is OR / floor knowledge, and there is NBME Surgery Shelf exam knowledge, with a minority of overlap. You need both to go for the gold on your surgery clerkship, and Surgical recall is the tool to help with the former.
Frank Netter’s Atlas of Human Anatomy 5th Edition is another must-have book for all of medical school and beyond, and serves as an excellent reference and resource for Anatomy class and the Surgery clerkship later in medical school. It also comes with Student Consult, which is an online resource library of other illustrations, supplemental learning resources, and anatomy dissection guides.
Anatomy hasn’t changed much over the years, yet they still tend to keep coming out with newer editions of Netter’s drawings, despite Dr. Netter passing away several years ago. Nevertheless, Netter’s Atlas of Human Anatomy is comprised of labeled diagrams, which provide clear pictures with ideal visualization, and overviews every inch of anatomic detail with precise vocabulary to help with easy recognition and retainment of human anatomy. The book itself is broken down by physical areas of the body, and details every physical structure and network, including nerves, arteries, and veins.
Many students find this an ideal way to study for Human Anatomy written exams, but as they are only drawings, some find cadaver pictures in books such as Rohen’s Color Atlas of Anatomy (reviewed here) to be a complementary supplement. The book is also well supported by the popular and more-portable Netter’s Anatomy Flash cards. As with all resources, it is recommended these are not brought into anatomy lab unless you want them quickly ruined with fat and fixatives.
The below links can be used to find and buy the cheapest version of Frank Netter’s Atlas of Human Anatomy.