What do you really know about surgery?

With limited exposure to surgery in undergraduate curriculums, how do you go about deciding on a surgical career, asks Iain Maronge

The degree with which I will hopefully graduate implies that I will be a bachelor of medicine and a bachelor of surgery, but what will I really know about surgery? How could you choose a career in surgery with little idea of what you are letting yourself in for, especially if you are training in the United Kingdom and pressured to decide a career path as early as possible? Previous articles in the Student BMJ have covered the details of what a career as a surgeon would be like; this article is intended to provide some ideas for where to start as a medical student. Its message is: seek out surgical experience wherever you can.

First contact

Your first experience of surgery can be surreal. I remember Meatloaf playing in the background to a radical laryngectomy while the theatre orderlies and anaesthetists talked about what they had been doing over the weekend. I was fascinated by the gory picture of a radical neck dissection and amazed at the delicacy and dexterity that the surgeon displayed as he worked among the mass of tissues and vessels that meant nothing to me. As interested as I was in the operation, I had to leave the theatre three times because I felt light headed. My senses were overloaded with new sights, the beeping of monitors, and the overpowering stench of burning that emanated from the diathermy. It also seemed such an inappropriate place to feel hungry.

Where to start

At the risk of stating the obvious, your medical school’s surgical society is a good place to start. They usually organise suturing workshops; lectures by eminent surgeons; and trips to national surgical institutes, such as the Royal College of Surgeons in the UK. You may even find organised trips to relevant events.

Next, be sure to make the most of all the opportunities that your medical school is offering. At Keele Medical School the surgical teaching fellows have established a surgical night experience for interested undergraduates. Some medical schools have surgical grand rounds, which give you the opportunity to present cases to your fellows and seniors and win prizes to beef up your curriculum vitae.

Clinical attachments

At some point in your clinical years you will be attached to a surgical team. If you are interested in surgery this is an exciting opportunity to get stuck in. Once you show an interest people are very happy to accommodate you and answer questions. Remember if you arrange with a surgeon to go to theatre then make sure you turn up on time—they are busy people.

The first step is to find out which patients are on the operating list (ask the junior doctors on the ward), take note of the procedure they will be having, and go and see them. If you do this the day before you will have time to take a history and examine the patient; read about the relevant anatomy; and find out a little about their procedure. This way you will make the most of your time in theatre and create a good impression.

In theatre, after you have been shown how to scrub, most surgeons are happy to let you observe and help in procedures. It is a great way to get a better understanding of anatomy in three dimensions and to begin to pick up some surgical skills. But be sensitive to your place in a working environment and be prepared for the fact that after you have botched a few attempts at a simple interrupted suture, it is time for the registrar to take over and get the patient off the table to allow the next one in.

It is worth going to the same theatre and surgical team regularly because by establishing a good relationship with the whole team and an understanding of what they do you stand a greater chance of being useful to them and so getting more opportunities. You can also get involved in research or clinical audits once you get to know the surgeons at your teaching hospital.

Student selected modules, intercalating, and electives

Most modern medical courses allow you to choose what you study for periods of about a month or so at various points, and this is another opportunity to explore surgery. There are usually several surgical options to choose from, and all will give you greater insight into particular specialties in the clinic and theatre settings. As is the case in Aberdeen, your medical school may offer a module in dissection in the final year, which would present a valuable opportunity to deepen your anatomical knowledge.

Some medical schools offer the opportunity to intercalate in surgery or a related area. Imperial College, London, offers a bachelor of science degree in surgery and anaesthesia, and University College London has the opportunity to intercalate in orthopaedic science. If a whole year seems too long, why not look into doing a summer research scholarship in an area related to surgery during your long vacation? (See “Working summer,” Student BMJ 2007;15:275-6, http://student.bmj.com/issues/07/07/careers/275.php.)

Electives are perhaps the last great opportunity at medical school to be immersed in something surgical, and there are many international organisations that help organise electives and placements. The International Federation of Medical Student Associations has a well established exchange programme, and “operation giving back,” from the American College of Surgeons, has international opportunities for medical students. When it comes to organising your elective, don’t forget that there are many prizes on offer for interesting electives sponsored by national medical institutions, such as the royal colleges in the UK.

Surgeons in real life

Real life surgeons do not spend all their time operating. Most surgeons spend at least as much time in clinic as they do in theatre, although the amount of time varies by specialty, and a big part of the workload is caring for patients in the surgical wards. Try to arrange to shadow some trainee surgeons on the wards and in clinic. It is also great fun and a good opportunity to practise your clinical skills and will no doubt mean that you spend some time in the emergency department, reviewing potential surgical patients. This is an important part of the job and any time spent clerking patients in the emergency department is well spent.

Think carefully about the practicalities of a career in surgery and be realistic about the stresses and strains of the job. I was recently given a useful piece of advice by a trainee surgeon, “Don’t look at what I do to decide if you want to be a surgeon; look at what the consultants do on a daily basis because that is what you will be doing day in, day out for the rest of your working life.”

If you’ve caught the bug

So if you decide that you like what you have seen and you think that surgery is for you then it is time to focus on building your surgical experience. For those readers in the UK, the website of the Royal College of Surgeons of England has a wealth of useful careers information, including a booklet entitled Career Options in Surgery.

Finally, you could attend conferences of surgical specialties, ask to be an observer on surgical skills courses, and check out essay or presentation competitions organised by your national surgical institutions. International surgical week this year is 6-10 September, and the 43rd World Congress of Surgery is in Adelaide. Subscribe to online membership of surgical organisations, like the Association of Surgeons in Training in the UK and the International College of Surgeons, and keep abreast of developments through surgical journals.