I was really surprised by how much I enjoyed my surgery rotation at New York Presbytarian Queens. I went into it with trepidation, but was quickly welcomed by my amazing preceptor, Annalisa, and the surgical team. I got to spend time on General Surgery, Urology, and Neurosurgery services. My first two weeks were with General Surgery. I was assigned to Team B, and rounded with the PAs and residents each morning. I also pre-rounded and presented a patient to the team each morning. This gave me experience with doing post-op follow ups, and it was rewarding to track patients progress throughout their hospital stay. The team was very eager to teach, and they always made me feel comfortable to ask questions. Each day I was assigned to various surgeries from different General Surgery teams. I got to scrub and get hands-on experience, which was very rewarding. I participated in many lumpectomies and axillary lymph node dissections for breast cancer, sleeve gastrectomies for obesity, skin cancer and lipoma removals, and hernia repairs. I worked on my suture and knot tying techniques, as well as developing my skills for reading CT scans. The attendings and residents would take the time to explain the necessity for the procedure, the possible complications, and the patients’ prognoses. On my 24 hour shift I joined the trauma team bravo when they were called to the ER. For my preceptor, I presented an H&P for a patient I had been following from his arrival in the ED to his discharge at the end of the week. I also prepared a powerpoint regarding his diagnosis, which was diverticulitis. My preceptor was very encouraging and helped me see which areas I needed to improve.
My third week was with the Urology service. I learned so much from the PAs on the team. At NYPQ these PAs have a lot of autonomy and are very involved in decision making regarding patients. Although the PAs were very busy, they took time to explain details regarding urology anatomy, urology focused physical exam, and the protocol for managing sepsis and septic shock. I enjoyed observing cystoscopy cases in the OR and got to scrub-in for vasectomies, circumcisions, and a penile implant. It was fascinating to learn about the different treatment options for renal stones, which depend on the size and location of the stone. I saw extracorporeal shock wave lithotripsy, laser lithotripsy, and percutaneous nephrolithotomy. I gained a lot of experience by going with the PAs to do consults in the ER. I also got to insert coude catheters as well as flush catheters to clear out clots. I presented two H&Ps to the PA team and their feedback and critique was really practical and helpful.
My last week in surgery was with the Neurosurgery service. This team does not have any residents, so the PAs work directly with the attendings in the OR as well as managing the patients on the floor. During morning rounds, I learned so much from the discussions regarding patient care. I also had the opportuning to remove drains and put staples in the scalp. I got to assist with the insertion of an intraventricular catheter to monitor ICP. This procedure is done at bedside and involves drilling a hole in the skull and making an incision in the dura at precisely Kocher’s point. In addition, it was fascinating to observe surgical procedures such as craniotomies to evacuate subdural hematomas and complex spinal surgeries including lumbar vertebrae fusion and laminectomies. I was also able to participate in an emergency decompression/discectomy for a patient who presented to the ED with cauda equina syndrome. During this rotation I got a lot more comfortable with assessing a patient’s GCS than I was before.
The timing of my rotation happened to coincide with NYPQ’s switching EMR from Allscripts to Epic. This made it particularly challenging because all of the staff were focused on learning the new system and getting it running properly. At the beginning, surgeries were often delayed due to difficulty with the EMR. I did my best to learn the new system and assist when I could. Despite the upheaval I was able to learn a tremendous amount from this rotation and really appreciated my time here. I really enjoyed the fast-paced nature of the surgical subspecialties and the hands-on experience. I would definitely consider working on a surgical team in the future.
Site Evaluation Presentation:
During my surgery rotation I met with Professor Herel on Zoom for two site evaluations. For my first evaluation, I presented an H&P about a patient with diverticulitis and 5 drug cards. Professor Herel gave me great detailed feedback. For example, he noted that I should specify which labs should be repeated in the morning as part of the plan for the patient. In addition, his evaluation was very encouraging while also giving constructive critique. Professor Herel suggested that for my next site evaluation I should choose a patient who was not previously known to the service, so that the differential diagnosis would be more of a challenge. For the final site evaluation, I prepared two H&Ps and 5 more drug cards.
I had my site evaluations with a classmate who is doing her surgery rotation at Metropolitan Hospital. It was really interesting to compare the different procedures and surgical subspecialties that we rotated through. We also had a great discussion about our pharm cards, especially regarding the appropriate use of certain antibiotics. My classmate presented an H&P about a patient with inguinal lymphadenopathy, and another about a patient with chronic headaches. Professor Herel facilitated a very productive conversation about possible differential diagnoses, and the testing needing to narrow down the list. Overall, I think my site evaluations went really well. I gained a lot from hearing my classmate’s presentations and from the feedback I received on my H&Ps.