I walked into the hospital on day one of my clinical rotations and got lost immediately. I am currently three weeks in, and while the layout of the hospital no longer confuses me, the feeling of being immersed into a foreign world—one which I know nothing about—has rendered this lost feeling a perpetual one.
I have started my clinical rotations in surgery.
Surgery has its own culture. It flows in a way that can only be learned by practice. A familiar analogy has been on my mind:
When you play basketball with teammates, it is effortless. Everyone knows the plays. Everyone is spaced appropriately. Everyone has unique roles, and sticks to them well. Everyone can predict another’s next move, and moves in sync with those predictions. Now – imagine someone who has never known the sport of basketball is placed onto a team and expected to perform with well-seasoned players. It would be clumsy and difficult.
This is what it feels like to be a new medical student in an operating room. It is a sink-or-swim situation; but sinking isn’t an option, and you aren’t quite sure how to swim.
That sounds brutal, so let me stop and say: It always turns out okay. Everyone who has graduated medical school has survived their surgery rotation. It just takes some adjustment, and it takes an ability to learn on the fly.
There are a few strategies I’ve adopted – both mental frameworks and logistical details – that have made it feel fun and experiential rather than threatening and embarrassing.
#1: Embrace this fact: Third year medical students are the dumbest ones in the hospital
My dad, a neurologist, chuckled when he told me this.
Physicians start out as clueless, wide-eyed third year medical students hoping that any of our preclinical education will be relevant for clerkships. Any expectations to escape the awkward transition from preclinical to clinical training is futile. We have one option: Accept and embrace.
But, don’t embrace this fact in a hostile, resentful way. Embrace it in a way that acknowledges how much growth is possible. Try your hardest. Look up information when you say you will. Say “I don’t know” with curiosity and zero shame. Understand that despite your best effort, you will not know the vast majority of information you encounter. Great! Keep a growth mindset.
Medical training is a long journey of naiveté in unfamiliar circumstances. The sooner we can adopt a “love of learning” mental framework around it all, the less painful these “I Don’t Knows” become.
Here’s my tip: Say “—and I love that” in your head each time you say “I don’t know” out loud. It changes the entire attitude from which you’re operating. If a surgeon asks, “Which fascial layer am I cutting into right now?” You have two “types” of I Don’t Know:
The “–and I love that version” is curious. I love that I don’t know. I get to be learning this! Right here! Which one is it? Can you tell me? No? Well, I’ll look it up afterwards. I love that I’m actually in an operating room right now rather than doing flash cards in the school library.
The other version is resentful. I don’t know, and I’m ashamed of myself. I should know. I’m so sorry. I’m an idiot. I read the wrong stuff I guess. I won’t come back into your OR, you must think I’m dumb. Sorry.
You get to pick which one of these you want to be.
#2: Practice surgical techniques and find a method to teach yourself things.
Clinical education is more immediately relevant to our future careers than the first two years of medical school. While I had to give myself miniature pep-talks to make myself memorize whether the sweet taste receptor uses an ion channel or a GPCR**, that why-am-I-studying-this experience isn’t happening with third year. I do want to learn how to suture. I want to know when to order a CT or when immediate surgery is indicated. I want to know which differentials to consider if a patient walks in with jaundice. This matters for my career.
During the first two years of medical school, there is an expectation that we will be taught, explicitly, what to know for the test. This changes in a clinical setting. A huge part of third year is practicing this stuff on your own. Find the online resources that work for you and dive in. Buy a suturing kit. Watch videos. Do questions. Lean into education more so than before.
It has felt great to answer “yes” when asked if I know how to suture, or to be able to identify structures on imaging – or any host of things that were made possible because I spent time learning on my own. These things are relevant now and will be relevant later.
Learn how to learn on your own.
3. Lose the defiance, even when you’re right
As mentioned above, surgery has its own culture. You’ll be told what to do and what not to do. Sometimes, different surgeons will tell you opposite things. Take it in stride.
Example: Students do a lot of retracting on a surgery rotation. During one procedure, a surgeon let me know ahead of time that he’ll position my hands where he’d like them to be, and I can hold there until waiting for the next positioning. Easy enough. At one point during the procedure, another surgeon came in to help out. The new surgeon became a little confused that I wasn’t predicting their steps and moving the retractors on my own – and gave me a 30-second briefing about how to tell where the surgeons will want retractors, and it helps them out if they don’t have to position me each time.
I was caught between opposing instructions. I said “okay, sounds good, thanks for teaching me!” And began to adopt the new instructions (and smiled to myself under the surgical mask). The topic didn’t come up again for the rest of the procedure.
It was extremely tempting to defend myself and say “actually, I was told not to move them on my own.” But afterwards, I was pleased that I didn’t. It would have created friction between the two docs in the room. It would have been pointless. Detaching from the need to feel right or validated was the appropriate choice.
The takeaway tip here, for surviving a surgery rotation, might be: Set your ego aside in order to be a team player. (And - for your own sanity.)
4. Worship – seriously, worship – technicians, nurses, MAs, and other staff
I am not saying this to be diplomatic. I am not saying this as virtue-signaling to offset the stereotype that medical students and physicians acquire. I am saying this because a surgery rotation will crumble to pieces without these humans.
The scrub technicians make sure we scrub in correctly, don’t touch anything we shouldn’t, and handle the tools properly. They keep the surgery moving smoothly. Don’t take a thing they say personally. Just thank them.
The nurses remind us when to be and where, give tips about different surgeons, keep us from making mistakes, and give a wink or a nudge when they can tell we need it. Thank them endlessly and help out with whatever they need.
Every MA I’ve met has been lovely to talk to and extremely helpful.
As a student, we’re clueless. Honor the help that exists around you, and never quit saying “thank you” when this much-needed help is granted.
This post serves as an introduction to both clinical rotations and my surgical clerkship. Got more ideas, questions, or comments? Contact me – I’d love to hear from you.
** It uses a GPCR.