Panda’s Quick n’ Dirty Guide to Third Year Rotations: Part 6

(Surgical specialties are usually grouped together in a one month block although they may do things differently at some schools-PB)

Surgical Specialties: Urology, Ophthalmology, Otolaryngology, and Orthopaedics

Your Real Responsibilities:
Nothing. You’re a medical student. You don’t count. And since you typically only spend a week on each service with the weekend off in between, you will matter even less than usual. You could get an inflatable sex doll, slap a short white coat on it, wheel it around on rounds, and nobody would notice a thing except maybe that the good looking chick in the back was unusually quiet for a medical student and didn’t ask nearly as many annoying questions.

Your Pretend Responsibilities:
Hardly any. Come on now. You’re on each service for a week. That’s hardly enough time to learn where they keep the paper-clips much less be of any use. If you subtract the time you spend in mandatory lectures or “Continuity Clinic”(if your school has this) your face time is even more limited and all you are really good for is getting in the way. If your residents don’t like to teach you will feel this keenly.

Things You Should Learn:
Urology: Common disorders of the male urogenital system. Impotence (or Erectile Dysfunction as it is called to avoid offending the impotent) is big. It’s the bread and butter (or potatoes and sausage if you will) of urology. Common presentation of urological malignancy like bladder cancer, testicular cancer, and the like. The prostate, of course. It’s huge. Probably deserves a blog of its own. Urge, stress, or overflow incontinence. Buzzwords: VCUG and TURP.

Otolaryngology: Anatomy of the head and neck. Dysphagia, odynophagia, and when to worry about them. Common malignancies. Otitis media gone horribly wrong. How to stand in the operating room doing nothing for eight hours pretending to be interested. Buzzwords: Uvulopalatopharyngoplasty. PET.

Orthopaedic Surgery: How to talk to an orthopaedic surgeon when you call him at 3AM. In other words, how to describe fractures and dislocations completely and succinctly. This would also be as good a time as any to review musculoskeletal anatomy. Simple casting and splinting and when to call a consult even if the xray of the wrist looks fine. Work on you upper body strength or stay out of the OR.

Ophthalmology: Common disorders of the eye. Glaucoma. Diabetic retinopathy. Macular degeneration. Now would be a good time to learn how to use that expensive ophthalmascope they made you buy. Recognizing ocular emergencies (retinal artery occlusion, detached retina, globe injury). Recognizing things that are not emergencies (hyphema, corneal abrasion).

Things That Will Suck
Not that much. It’s a pretty good month with no call (typically) and no pretenses that you are part of the team and thus no need to fake enthusiasm. Still, if by this time in your career you are sick of shadowing (following a doctor around and watching what he does) you are going to be unhappy as you will do a lot of this.

Urology clinic is painful. Call me a homophobe but I lost interest in holding some other guy’s wedding tackle after…let’s say…thirty seconds. For being a holder, Boy George had nothing on me that week. I also do not, repeat do not, want to hear seventy-year-old men telling me about their sex lives. Sorry. If I give you some Viagra will you shut up? I find discussions of how your penis broke particularly disturbing.

I’m not mature enough for urology.

As I mentioned, head and neck surgeries of the kind you might get sucked into unless you have your slacker game on can last for days. I made the mistake of scrubbing in on a facial reconstruction surgery that started at 8AM and ended at some unknown time after 4PM when I had to scrub out for a mandatory didactic activity. I have never been so happy to sit in a conference room talking about empathy.

Cool Things About the Rotation:
Not that much. I guess it depends on you level of interest. I had a friend who had always dreamed of being an orthopaedic surgeon and he had the time of his life. It was bearable, the hours weren’t that bad, and it’s mostly interesting stuff when you think about it. If you don’t like something, well, it’s really only five days. I can endure anything for five days. By the time you’ve had enough it’s Friday afternoon.

None, generally. And since you’re something of a cross between a migrant worker and a hobo, nobody really knows you and it will take a supreme effort of will for your resident to remember your name, even if he wanted to wake you up at 3AM. Ophthalmology and Urology are not “call heavy” specialties either so even if you did have call, you’d probably do less than the resident.

Slacking Potential:
Fantastic. Got some personal business to attend? Significant other coming to town? New game console? Sponge Bob marathon? For a slacker this is your month and it will have everything: Rapid turnover? (check). Busy residents? (check). Confusion? (check). In fact, you could probably not even show up and nobody would know or care. I am a resident. I usually don’t know my medical students unless they introduce themselves and say, “Hey, Dr. Bear, I’m Joe Schmuckatelli and I’m working with you this month.” Imagine if the medical students switched every week and some weeks there were no medical students at all. And how do I know if you don’t actually have lecture, for example. Hell, I don’t even know your name. If I even care and you gave me some vague excuse or another I still wouldn’t care.

Let’s just say that if you have just come off of six months of general surgery, OB-Gyn, and medicine this rotation will give you a much needed breather. My wife referred to my surgical specialty month as “that month when you were home a lot.”

One thought on “Panda’s Quick n’ Dirty Guide to Third Year Rotations: Part 6

  1. I would kind’ve like this way. We don’t do it like this at all. We get thrown onto a single surgical sub for three weeks.

    I suppose less slacking potential.

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