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Hello,

I'm starting 3rd year clerkship rotating through general surg in 2 weeks time. As the title suggests I'm interested to hear from anyone who has experience what the most high yield operations are. For example I know appendicitis is seen a lot in general surgery, are there a number of ops that I should absolutely read around before my rotation?

Thank you 

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On 8/15/2021 at 11:41 PM, anonymouspls said:

Hello,

I'm starting 3rd year clerkship rotating through general surg in 2 weeks time. As the title suggests I'm interested to hear from anyone who has experience what the most high yield operations are. For example I know appendicitis is seen a lot in general surgery, are there a number of ops that I should absolutely read around before my rotation?

Thank you 

Not a surgical resident, but as a clerk it would be more beneficial to know more complete management of surgical cases, rather than specific details about the operation. From time to time, you may get pimped on some anatomy in the OR, but what would impress residents and staff more would be how to take an effective history and physical, a good differential for the surgical presentations (for e.g. knowing the difference between cholelithiasis, choledocholithiasis, acute cholecysitis, or cholangitis) and how to work-up and manage these patients. That would be more high yield than the step by step OR management. As a clerk you will not be spending the majority of your time in the OR, at least not operating.

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It really depends on what service you are on. If you are on acute care surgery, expect to see lap appys, lap choles, lysis of adhesions or SB resection for SBO. If you are doing elective general surgery, expect to see hernias, endoscopy, colonoscopy and possibly hemorrhoids or lipomas thrown in the mix as well. Right hemicolectomy, sigmoidectomies are probably the most common colorectal operations you'll see if you were to do CRC. On HPB, expect to see Whipple's, distal pancreatectomy, complex choles and liver resections. On breast you'll see plenty of lumpectomies, mastectomies.

 

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6 hours ago, Edict said:

It really depends on what service you are on. If you are on acute care surgery, expect to see lap appys, lap choles, lysis of adhesions or SB resection for SBO. If you are doing elective general surgery, expect to see hernias, endoscopy, colonoscopy and possibly hemorrhoids or lipomas thrown in the mix as well. Right hemicolectomy, sigmoidectomies are probably the most common colorectal operations you'll see if you were to do CRC. On HPB, expect to see Whipple's, distal pancreatectomy, complex choles and liver resections. On breast you'll see plenty of lumpectomies, mastectomies.

 

What does a community GSx do? As med students we're exposed to the tertiary centre care but most specialists will end up working in the community. Thanks in advance

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On 8/18/2021 at 2:32 PM, CaRMS2021 said:

What does a community GSx do? As med students we're exposed to the tertiary centre care but most specialists will end up working in the community. Thanks in advance

In the smaller community centres i have worked in they tend to be very general: All the classic abdominal surgeries (appy, chole, hernia repairs, bowel resections and ostomies), breast biopsies and mastectomies, upper and lower scopes, and some ambulatory procedures (like carpel tunnel, visectomy, hemorrhoids, more complicated ganglion/derm excisions, etc). Most of the stuff mentioned above. 

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I barely spent any time in the OR and mostly was doing admissions and post op management. That was fine by me—I don’t do well in an OR (hence psychiatrist!!).

learn all about everything above but having an idea about what’s normal for vitals, labs, ins and outs post op, general note taking/presentation approach for surgical admits and discharges goes a long way. And, know an acute abdomen when you see one.  
good luck!

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On 8/16/2021 at 9:09 PM, Snowmen said:

If you think there are a lot of appendicectomies, wait until you see how many cholecystectomies they do...

It's easily half the cases if you're not a subspecialty surgeon.

 

On 8/16/2021 at 10:48 PM, 1D7 said:

Hernias, appendixes, gall bladders.

There's a lot of bowel work too so things related to obstruction (colorectal cancer) and IBD are not uncommon.

 

On 8/17/2021 at 6:34 AM, robclem21 said:

Not a surgical resident, but as a clerk it would be more beneficial to know more complete management of surgical cases, rather than specific details about the operation. From time to time, you may get pimped on some anatomy in the OR, but what would impress residents and staff more would be how to take an effective history and physical, a good differential for the surgical presentations (for e.g. knowing the difference between cholelithiasis, choledocholithiasis, acute cholecysitis, or cholangitis) and how to work-up and manage these patients. That would be more high yield than the step by step OR management. As a clerk you will not be spending the majority of your time in the OR, at least not operating.

 

On 8/18/2021 at 10:25 AM, Edict said:

It really depends on what service you are on. If you are on acute care surgery, expect to see lap appys, lap choles, lysis of adhesions or SB resection for SBO. If you are doing elective general surgery, expect to see hernias, endoscopy, colonoscopy and possibly hemorrhoids or lipomas thrown in the mix as well. Right hemicolectomy, sigmoidectomies are probably the most common colorectal operations you'll see if you were to do CRC. On HPB, expect to see Whipple's, distal pancreatectomy, complex choles and liver resections. On breast you'll see plenty of lumpectomies, mastectomies.

 

 

On 8/18/2021 at 4:32 PM, CaRMS2021 said:

What does a community GSx do? As med students we're exposed to the tertiary centre care but most specialists will end up working in the community. Thanks in advance

 

20 hours ago, frenchpress said:

In the smaller community centres i have worked in they tend to be very general: All the classic abdominal surgeries (appy, chole, hernia repairs, bowel resections and ostomies), breast biopsies and mastectomies, upper and lower scopes, and some ambulatory procedures (like carpel tunnel, visectomy, hemorrhoids, more complicated ganglion/derm excisions, etc). Most of the stuff mentioned above. 

 

1 hour ago, LostLamb said:

I barely spent any time in the OR and mostly was doing admissions and post op management. That was fine by me—I don’t do well in an OR (hence psychiatrist!!).

learn all about everything above but having an idea about what’s normal for vitals, labs, ins and outs post op, general note taking/presentation approach for surgical admits and discharges goes a long way. And, know an acute abdomen when you see one.  
good luck!

Sorry to bother you guys again but I just learned I'm starting with plastic surgery first, then another surg selective then Gen surg.

 

I guess the same question stands - what should I do in the next 10 days to prepare? Keep in mind I'm 100% a rads gunner so have little interest in plastics or any surg. I imagine for plastics the most high yield topics would be hand and skin anatomy? 

 

Thanks

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Apply the above to common plastics cases. 
it is not just hands and skin. It’s all anatomy. Breast. Trunk. Extremities. 
This should be relevant to you because surgeons order imaging often, and if your interest is in rads your anatomy knowledge should be very good. 
again learn about labs, taking a history, post op treatments and management.

it’s clerkship. They don’t expect you to know it all. You’ll rotate through surgery in rads, though, so probably important you build some skills as a clerk. GL!

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15 hours ago, LostLamb said:

Apply the above to common plastics cases. 
it is not just hands and skin. It’s all anatomy. Breast. Trunk. Extremities. 
This should be relevant to you because surgeons order imaging often, and if your interest is in rads your anatomy knowledge should be very good. 
again learn about labs, taking a history, post op treatments and management.

it’s clerkship. They don’t expect you to know it all. You’ll rotate through surgery in rads, though, so probably important you build some skills as a clerk. GL!

This. If you're a radiologist, you need to know the anatomy on the tip of your fingers and you need to understand what the people asking for imaging are looking for, and surgeons ask for a ton of imaging.

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