10-Where to Do Rotation?

I Want to Be a Doctor

Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a second year medical student who asks where should I do my surgery rotation?

Life is so full of the question of where! When you are in preschool and elementary school, your parents are typically choosing your schools for you. But as you get further along, you have to start making these decisions and they never really end. Someday it will be where to live, where to work, maybe even where to send your own children for preschool. So I'll answer this both more generally for people who are choosing a college, medical school, or residency as well as your specific question.

So the first and most important thing to realize is that in general, wherever you do any of those things, you’ll be fine so long as you’re safe and have some learning and are reasonably happy. Sometimes people worry that they need to get into the right school or program to have the right life. There is not one right school. I know people who went to top schools and top residencies and they are no happier than people who went to state schools and residencies in places you didn’t know exist. Patients don’t care where I went to high school or college or residency. They just care that I’m there for them. If someone only respects you because of where you went, they don’t really respect you, they respect the place you went.

Some people do want to be top in their field internationally and that’s great if that’s you. In that case, you’ll be driven by the field rather than the school. You'll have to find where to go for that specific area because there isn't one top place for everything. But that’s a whole separate path and beyond the scope of this episode.

So for today I’m going to assume you’re a medical student who wants to be a good doctor.

There is not one right place to do your surgery rotation. It all depends what your goal is. If you’re going into surgery, you’ll probably have multiple surgery rotations and you’ll choose each one to fit different goals, one for lots of experience, one for making connections at a program you might be interested in, a couple for trying out different subspecialties in surgery. If you’re not going into surgery, decide what your goal is. Be totally honest. Do you want to have a lot of time actually doing procedures? Do you want to avoid ever having to? Are you just wanting to pass or do you really need to honor for your career goals?

Once you’ve decided what your goal for the rotation is, think about where you can best meet that goal.

I knew I was going into primary care so my goals for my surgery rotation were to learn what my patients might experience and to learn some basic procedural skills. I asked lots of 4th year medical students who had already done their surgery rotation, the pros and cons of different options. Remember that whoever you ask may have goals that are different than yours. In fact, one of the students who led me to the site I chose had nothing but complaints about it including the fact that you were expected to assist on multiple surgeries a day and round on those patients in the morning. That sounded great to me!

On my surgery rotation, I mostly was at a small community hospital but I tagged along with my intern a few times when she went over to the University hospital. There was a stark difference in my experience.

At the community hospital I was often the first assistant, meaning that I was standing directly across from the surgeon and got to see everything and help in anyway I knew how. I often stayed late to assist with surgeries that were added on at the end of the day so I got extra experience and a reputation for being a hard worker. I tried to be a pleasant person to teach, eager and grateful, and surgeons would invite me into surgeries that I didn’t think were available to me.

I got to close up a lot of incisions.

By the end of the month, I would just look at the surgery schedule to see what was happening and pick whatever looked fun. It was a great rotation!

Meanwhile, when I went over to the university hospital, I was usually in a cluster of several other medical students standing down towards the end of the table and there was always a resident or two as the first and second assistant. If there was only one resident, the second assistant would be a 4th year medical student who was going into surgery. While it was really interesting to see complex cases that I wouldn’t have seen in the community hospital, there was no opportunity to assist on the complicated cases.

I asked the other students and they said that they assisted on a few surgeries a week, but they were the same exact sorts of surgeries that you can assist on in any hospital...gallbladders primarily. General surgeons take out so many gallbladders. There were lots more surgeries going on but there were so many surgeons and students that many of them didn’t get to know each other well enough to build the trust necessary to be allowed to do very much.

But wow, there was so much cool stuff! I saw a lifesaving trauma surgery and an actual organ transplant. I saw a machine that pumped someone’s blood outside the body and literally touched the patient’s heart (every student was allowed to take a turn). It was one of the most incredible experiences of my life to actually place my hands on a warm, living, beating heart.

So for someone who wants in on those really complex and high intensity surgeries, you need to go to a large center where those surgeries are done. Or for someone who didn’t want to have to assist, it would have been a great rotation because it was possible to almost completely avoid assisting. You'd have to ask around if there's a rotation with less assisting at your program. And for someone who wanted to go into surgery, it was very important to have at least one rotation at the University Hospital because of the complexity of cases and to up the chances of getting to go there for a sub-internship, which is something you do your 4th year to show that you’re ready for internship and try out residency locations. And there were students who were able to develop relationships with surgeons and have more opportunities. They just had to work at it more and be better at standing out from the other students.

Ultimately, any location would have been fine. I would have learned a ton and taken the next step towards my career no matter where I went. If you end up going somewhere you didn’t plan on going, you may see something that you’ll need a decade down the road, so go into it with an open mind and heart, always knowing that you are there for a reason.

That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values.

Please send your questions to me at [e-mail]. That's podcast at d-o-c Robin like the bird school dot com.

Show notes are available on the podcast website linked below.

This episode was sponsored by Dr. Robin's School, the first pre-medical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado.

https://podcasts.bcast.fm/i-want-to-be-a-doctor