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17. Surgery: The Good the Bad, the Ugly?
130 Plays2 years ago
In this episode, we talk about three different surgical experiences and how our guests succeed in this intimidating rotation.
I would like your input, what topics would you like to hear?
Let me know by sending it to thepaschoolexperience@gmail.com
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Transcript
Introduction to PA School Experience Podcast
00:00:13
Speaker
Welcome to the PA School Experience Podcast. I'm your host, Sebring Sands, and I take you through the behind the scenes look of PA School and explore what it takes to become a PA.
00:00:33
Speaker
If you have been wondering how I could do this podcast in PA School, I'll tell you, I use an anchor. This is the easiest way to make a podcast. Let me explain. First, it is a free hosting platform which allows anyone to start a podcast with no upfront cost. It has built-in tools which allow you to edit and record a podcast. You can even record it from your phone.
00:00:56
Speaker
Anchor will distribute your podcast for you so it can be heard on Spotify, Apple Podcast, and other major podcast platforms. You can make money from your podcast with no minimum listenership. Anchor has everything that you need to make a podcast. They make it so easy for you. Download the free Anchor app or go to anchor.fm to get started. That's anchor.fm A-N-C-H-O-R.fm to get started today.
Meet the Guests: Surgery Experiences in PA School
00:01:27
Speaker
Welcome everyone to another episode of the podcast. It's been a little bit, things have been crazy, but rotation, life goes on. We're here with a couple of new guests today and we're excited. We're going to talk about surgery and the good and the bad and maybe the ugly, hopefully not so bad. And we'll have fun and we also have a recurring guest, Nick.
00:01:53
Speaker
the president day of the cohort 2023, so he'll be on as well in a little bit. And we'll have lots of fun and hopefully share some great stories and cry a little bit, laugh together in all the emotions. Let's get started. So do you guys want to introduce yourselves? I'm Gabby Zarlenga. I'm a PI student at Sacred Heart University in the same class with Nick and Abby. And we had our surgery rotation first.
00:02:22
Speaker
My name is Abby Baxter and I'm also a PE student with Gabby and Nick. And yeah, we just had our surgery rotation. Yeah, for the first one, that's pretty daunting. How did you guys feel before you even went to the rotation?
00:02:38
Speaker
It's so scary. Very intimidating, like never having scrubbed in before and kind of just like, I mean, obviously I used to watch Grey's Anatomy and all that stuff and kind of scared me a little bit if that's what it was really like, you know? Is it anything like Grey's Anatomy? No. Unfortunately, it's like one of my favorite shows, but no, it's not like Grey's Anatomy. There's no, there's not, well, there's some drama, but not that much.
00:03:09
Speaker
Good. I'm glad real life isn't like that because that'll make my life a little less interesting, but it's okay. The thing about medical shows I've realized is they have to really amp it up or else it's going to be so boring.
Fears and Challenges in Surgery Rotations
00:03:21
Speaker
Yeah. Because if you follow anyone in healthcare, it's kind of boring. So you kind of have to amp it up. So anyway, so what were some of the like horror stories you're kind of going into the rotation? Did you hear any? Were you?
00:03:37
Speaker
ruminating on some stories you've heard from friends or from the internet. I heard from someone from a past cohort that two things, one that someone's fake eyelash like fell off into an open body cavity. So I was like, oh my God, no rings, no jewelry, like no nothing, don't mess this up. And then the other thing was that while someone was observing, they
00:04:06
Speaker
scratch their nose without thinking and then they were taken off that surgeon's cases for the remainder of their rotation because they broke sterile field. So yeah, that made me very nervous. I remember the first time I went in, I was like, don't scratch anything. Keep your hands on the blue and the table. It's like pretty much all I said to myself for the first week in my mind.
00:04:34
Speaker
I know those were I feel like I was scared about first of all getting pimped like I was scared I feel like that's such like a thing that people talk about I was scared I would get pimped really bad and yelled at or kicked out of the OR if I got something wrong. I'm scared about breaking sterile field like Gabby said or I was scared I would like pass out like obviously we're in I don't really get grossed out like I've worked in com cadavers and stuff but like I've never been in an OR so I was like what's gonna happen am I gonna pass out am I gonna
00:05:04
Speaker
I don't know. That's what I got nervous about. I didn't. It was all fine. And they're actually so nice about that. In my rotation, the first surgeon I worked with was like, have you seen blood yet? And I was like, no. And she's like, okay, well, here's the protocol. We have a stool behind you. If you feel dizzy, let me know. Put your hands up, back away, and someone will catch you.
00:05:27
Speaker
And I was like, oh, okay. Like they've had this happen before. This isn't a rarity. So they were very understanding and they kept checking in on me. They're like, you're okay. Okay. I was like, yeah, doing great. This is pretty cool. Okay. Okay. Yeah. I think my worst fear is the pimping you'd hear about it. And then I was, unfortunately I was very into Reddit and you hear all the horror stories on Reddit. Um, but that was my definite fear going into surgery.
00:05:56
Speaker
Um, wasn't really the case for me, which I'll get into, but yeah, those are some of the things we all worry about surgery. Nick,
Surgical Residency and OR Responsibilities
00:06:05
Speaker
thanks. We're glad to have you. Do you want to introduce yourself again to all the, our awesome listeners to the podcast?
00:06:12
Speaker
Yeah, thanks for having me. Sorry, I had to jump on the left over here, but yeah, I'm also one of, you know, also in the class of 2023 here at Sacred Heart, finished up my surgery rotation and then orthopedic surgery. And yeah, excited to hop on here today and kind of talk about our experiences and yeah, hopefully help some other folks down the road who listen to this.
00:06:33
Speaker
Awesome. So I've heard that you guys had pretty different surgical experiences. So I kind of want to briefly have you guys talk about them. What was your experience like in the OR? How much assisting? How much things you actually were able to do in the OR? And just overall atmosphere, the good, the bad. Yeah, just things we talked about briefly and then we'll chat about other things.
00:06:56
Speaker
But yeah, no, I think we all three of us definitely talked a lot throughout and had very different experiences. I, you know,
00:07:04
Speaker
felt like I was really trying to be active, to be involved in the OR, but the hospital that I was at has a surgical residency program. So it was kind of like second assisting, which for laparoscopic surgery is kind of like watching wall sterile. So it's just kind of like whatever. And you do that like 30 times and you're like, all right, this is really great training. But the benefit is that we got a lot of experience like pre rounding on patients, rounding on patients, learning kind of like the floor medicine aspect of
00:07:33
Speaker
surgical patients, which I know, depending on where you are, can be really different. So that was the one benefit. I think that helped the EOR as well. In my experience, Nick and I would kind of talk every week about our experiences because we realized they were so different. I first assisted kind of frequently. I was in the OR every single day assisting in some capacity on multiple procedures, and I rounded on patients once.
00:08:03
Speaker
And we didn't pre-round and I didn't have that floor experience that Nick had where there were like grand rounds and a lot of patient presentations. Mine was mostly OR based.
00:08:22
Speaker
I do feel like probably having a bounce between that is best, but for a surgery rotation, I'm happy that I got to be more hands-on in the OR because you're gonna have hands-on experience with patients in other rotations when they're awake. But yeah, it was rare that I spoke to a patient who, at all, because most of them were under anesthesia.
00:08:50
Speaker
I know. I think my experience was definitely more similar to Gabby's.
PA Roles and Autonomy in Surgery
00:08:56
Speaker
I didn't round at all. I didn't talk to one patient the entire rotation. They were all asleep. So we didn't do like the rounds or pre-ops or post-ops or anything.
00:09:06
Speaker
which I didn't mind at first. I guess I still didn't really mind. I think it would have been helpful, but I do. It was my first rotation. I have many other rotations to be able to do that. And it was definitely cool. We didn't really have med students or residents there.
00:09:21
Speaker
So I did get to first assist on a lot of the cases and suture and practice stuff like that. I did get pimped, I think, more than some of the other rotations. It depended on the doctor, but some of them did pimping. But it wasn't as bad as I was expecting. I think it was good. You learned from it. You learned how to prepare for the cases and what kinds of questions they were going to ask. I liked it overall. It was helpful.
00:09:46
Speaker
Okay, interesting. That's very interesting. Yes, I went the same rotation Nick did, and when you have a residency program, it's not more formal. So I do a lot more formal teaching. I have grand rounds, I have more structured rounding and things like that, especially for the floor.
00:10:05
Speaker
that it's mostly for the residents. And we're just there to kind of participate a little bit in our capacity. And especially where we were at, we also had a couple of med students sometimes. They would rotate in and out. So you have that structure. And it's interesting to get the other side of it. Usually, programs that don't have residencies mostly just rely on PAs. Did you work with PAs? And they just let you first assist?
00:10:32
Speaker
Gabby and Abigail, was that kind of the structure? Yeah, I was with a full surgical PA team. So depending where they, they would just put me alone on the schedule sometimes to persist. I was kind of just wherever I was needed, but I was again, not in a program where there was a surgical residency program. I was the only student in the hospital.
00:10:57
Speaker
So whenever there was need for someone to hold a retractor or something like that, I was the person that they would schedule in. So they kept me pretty busy in the OR. But yeah, I think that when you have the med students in the mix, you have less of opportunity for that. I think it's different to like,
00:11:22
Speaker
Um, I had it like every, cause I, I've spoken to people who have been at the site that we were at. Like after I went and they didn't get along really well with the med students residents, but like I really did. And it's definitely, I don't know, a good opportunity for us to like approach that. Those, all those interactions, like as well as we can, because it's a good chance to educate them on what our education is like and what we do and how similar we ultimately are in a lot of ways more than I think that we're different. And I think.
00:11:50
Speaker
That's a big help for sure. Yeah, just thought I'd mention that. I thought it was interesting. I'm not going to win everybody overnight.
Training, Autonomy, and Job Satisfaction in Surgery
00:11:57
Speaker
No one's going to be your best friend, but it was cool to at least get to study with the med students and interact with the residents and kind of fill them out a little bit. Yeah. A note for PA advocacy. We were with Columbia students.
00:12:16
Speaker
And I didn't feel like we were much different from they were. They had a little bit more knowledge and I was with a MD PhD guy and he was very intelligent, but very nice. I didn't feel that much, I wouldn't say inferior, but I felt like our educations were very much similar and they were 30 years too, similar to our getting clinical year, but I didn't feel like
00:12:40
Speaker
I was behind them during that surgical rotation. I felt like I had similar skills that they did. They didn't have any special crazy medical student skills that made them better in the OR or anything. It's just being observant and having that situational awareness in the OR.
00:12:58
Speaker
So that is the thing. Sometimes I think PA students get a little intimidated with medical students because they have two years preclinical and then they have all these crazy rotations. But PA education and medical school education, when it comes to nuts and bolts of a clinical rotation, we're pretty, I feel like we're pretty
00:13:20
Speaker
on par, so we don't have to feel intimidated by that. I feel like that's just a note that I noticed in that setting, which is really cool. So what were the most favorite fun things that you did during the rotation, the surgical rotation, that you enjoyed the most, I guess? You mean which surgeries? Well, surgeries or things you were able to do during the rotation, the rotation itself,
00:13:47
Speaker
The coolest surgery that I saw personally, like I have an interest in OBGYN. Um, so it was a robotic hysterectomy and it was so cool. Like the surgeon was basically in a corner with, it looks like a video game, honestly. Um, and I, I couldn't believe like what technology could do. And it was, I'd never seen a robotic surgery ever.
00:14:14
Speaker
So that was very, very cool to see. Aside from surgery, there was a pretty cool retirement party on the back patio that had a carving station and sushi and awesome stuff. So that was a pretty good experience as well. It was fun. And when you asked that question in Subaru, I was like, I mean, leaving every day was like pretty fun. Leaving the hospital, especially early.
00:14:40
Speaker
What's it called? I don't know what was like fun. I don't know. Like I did like, uh, I got to do a lot of like a ruin Y procedure. Like once that was kind of kind of cool, just with like a resident and the surgeon kind of like supervised. Um, what else is fun? I don't know. It'll come to me. Oh, just, I guess learning, I think it's a location dependent, but, and I know they try and place us like,
00:15:06
Speaker
where they think it'll fit our personalities, but I essentially had absolutely no schedule, no accountability,
Site and Rotation Variations in Surgical Training
00:15:14
Speaker
responsibility, or anything. So being able to kind of make the most out of it if you wanted to and just kind of have free reign is kind of cool. And I think it almost, for some people, leads to a better experience overall if you're not being constantly forced into doing certain things.
00:15:32
Speaker
I think my favorite was probably, I got to jump in on a few like plastics cases and like breast reconstruction and stuff like that. I think that was pretty cool. Did a lot of gallbladders, like gallbladder, hernia, and appendix. I think we probably, I probably feel like I could do it by myself right now. I couldn't, but it was like,
00:15:56
Speaker
Anything that wasn't that was exciting to do just because we did so many of those. So when there was like something else that popped up that I could go and jump in on, I was really excited to do that.
00:16:06
Speaker
It's like so interesting because I was mostly an ortho and I probably, I think I did two gallbladders the whole time I was there. That's crazy. So yeah, it was like a little bit of everything. I did multiple like that redectomies, breast stuff. I did some pediatric urology. So I even did like some circumcisions. It was like, I got to do a bunch of stuff. So.
00:16:36
Speaker
I was like, not a master at anything, but kind of like, jack of all trades, I guess, in that sense, within my rotation. Yeah. That's really interesting to me, because I've heard that a lot of that, even at the same sites, in between like, you know, which students are there in whatever, every rotation, like surgically, so different, like, I had no ortho, no OB, like, I would transcribe into those cases. And they're like, no, it was just like, you're gonna do GI stuff. So it was just GI stuff.
00:17:05
Speaker
which definitely made ortho a lot more enjoyable, I think, when I got there, but it's interesting. And I'm sure Sebring might have even had a totally different experience scrubbing into cases at the same hospital I was at, you know, a year prior. Yeah, very similar. Because Stanford, we had as dedicated ortho rotation and OB rotation, we didn't do those just general surgery. It was okay. The surgeons were actually really nice. I never got pimped. There's only one that you kind of ask questions.
00:17:34
Speaker
But the thing about being pimped in the OR is if you know at least a little bit of the anatomy, that's what they mostly do it on. Anatomy, but anatomy is tough too because surgical anatomy is way different. Looking at just a small section and going through all the layers and all layers are all stuck together isn't like any
00:17:55
Speaker
very defined separations of skin layers and things like this and and muscles and everything it's all mixed together it's so hard so kind of knowing a little bit prevents a lot of it but i in all i have four surgical rotations i hardly have gotten pimped on any of them and that's really a dependent on the location
00:18:17
Speaker
What I've noticed about that though is most surgeons just want to be done. They just want to get done there. They want to do their job and they want to get me done because they have lots of other surgeries. I think that the ones where you get pimped on a lot more, usually like more routine ones like gallbladders where they like our fault, like can do it in their sleep and that they entertain. They ask a lot of questions. I've noticed a lot.
00:18:44
Speaker
Um, but like, especially ortho, they're so, they're so concentrating on like just doing it. Cause it's, it's a lot of thinking and there's a lot of planning. They're just wanting to get in there, do the job, not have any complications and get out of there. Um, so that reduces, I think a lot of anxiety. Yeah. If you're going to a Harvard type place where these guys are like so skilled in their field, they might do a lot of that, but a lot of other places.
00:19:13
Speaker
they're just asking you. If they do ask some questions, a lot of times it's, yeah, he's asking you questions because the surgeon's busy, the PA is not doing anything, and they want to ask you questions.
Developing Surgical Skills and Etiquette
00:19:23
Speaker
I was mostly, because I was mostly in some ortho cases, I was in hoods a lot with the fans so no one could hear anyone. So I didn't get pimped often either. And even if they did try to ask me a question, I'd be like, what? And then they'd be like, nevermind. So that was, that was pretty much my experience with pimping. That's pretty funny because I'm wearing Sebring and I had the same experience where having surgery and then ortho surgery.
00:19:50
Speaker
very little pimping aside from maybe perioperative management. So maybe if you're a didactic student listening to this, you know, they might, they never asked me about like the procedure, even though like I was like, Oh, I studied this whole case. Like I know what they're going to do next. They'd be like, what do you think about beta blockers in this patient? Like, like, why don't, why are you asking me that? So surgeons might be really interested in, in patient management. I know you guys, you both shook your heads in disbelief because I know Abby especially got the works in terms of pimping. Hopefully she can talk about that.
00:20:20
Speaker
I learned the hard way because the first few days like I didn't really get pimped or anything like it was more like easier than all of a sudden we were doing I forgot what it was I think it was like
00:20:32
Speaker
a hernia or something and the surgeon started asking us a lot of questions that like obviously I prepared for a hernia case because I knew I was going into that and they started asking questions about something completely else like we were got quizzed about all the muscles and like the nerves in the lower leg which I
00:20:51
Speaker
was not thinking about because I was studying for my EOR, I was studying for the hernia, I just completely forgot about that anatomy. So that was a little hard. But other than that, it was mostly case dependent, like the breast surgeon I was with. She was amazing, but she was definitely tough. Like she would ask, I think,
00:21:09
Speaker
20 questions to me within the first five, 10 minutes of the surgery, like rapid fire. But I was told that she did that, so I prepared a little bit. I found if you go on Quizlet and you look up like this surgery pimping questions or like gallbladder pimping questions, there's actually some good ones on there, and the surgery recall book helped. But
00:21:30
Speaker
I definitely think I did get pimped a lot more than some of the other people but it was good to be prepared like I would watch YouTube videos the night before each surgery and figure out like oh this is the nerves they don't want to hit like this is what they cut um what would happen if you hit this nerve if you cut this nerve um a few drug questions too I got asked about like
00:21:51
Speaker
how, like, expiral, what is it, like, what drug is it, how does it work, like, mechanism of action, stuff like that. But I think it was good. None of it was too, too bad, right? Cried or got too flustered or anything. Like, they all made it pretty, pretty good. They made it a good learning experience.
00:22:10
Speaker
Just to go off that quickly for those of you listening who might be going into surgery, I know a bunch of us use the touch surgery app to prepare for our cases in case we got pimped. And that is a great tool you go on and you can basically do the surgery.
00:22:26
Speaker
step by step, it takes you through all the different anatomical landmarks and things that you should be looking out for. So that definitely helped me in like the very few general cases that I was in, because they did ask me like, you know, your basic anatomy questions within that. And it was nice to have like the layers of the abdomen and things like that. Totally. I also helped for Ortho a lot too when knowing like the different steps. And going off of like what Abby was saying reminded me
00:22:55
Speaker
I don't know if this helps or not. Sometimes, you know, like I think, I don't know, maybe you told me to see brings sometimes when people like when they pimp you, it's kind of because they want you to learn the stuff. So they'll, if you get it wrong, they'll tell you it, tell you it, or want you to look it up and whatever. And like they're not, which I never got pimped. That means they don't really care or they're too busy, but I would like avoid being pimped by like reverse pimping the surgeon, because I would like be really excited to be in my orthopedic procedures. And I would like study.
00:23:21
Speaker
like to the nth degree of the surgery and I'd be asking them like about like the angle of which they're going to cut like the tibia for like a knee replacement. And they're like, why are you asking about this? Like, and then they know that you want to learn and then they start telling you stuff. And then, so they're like, okay, this person isn't like a complete dud. But they're like, these are like really oddly specific questions for you to know. So pro tip, I guess, if you're actually really into a surgery, study the hell out of it and
00:23:50
Speaker
really weird the surgeon out and it kind of throws them off guard. Yeah. Oh, sorry. That's a good idea. That's great. Sorry. Even just asking like basic anatomy. Oh, is that the cephalic vein? They're like, Oh, it is just like, so then they're like, okay, I don't need to ask them questions. If you ask them questions, it leaves less room for pimping, I think. Yeah. Or sometimes, yeah, you're rolling a dice with that though, because
00:24:17
Speaker
they can be like, yeah, it is totally. Or they can be like, yeah, obviously, I've gotten that a lot. But like, yeah, obviously, I know. They're like, I'm just asking. I think I got lucky. All the surgeons I work with were so nice. And they were just like, so willing to teach me a lot of them just talked out loud to themselves through the procedure. And that was amazing. Because I could just hear, you know, their thought process of why they were doing certain things.
00:24:44
Speaker
That's awesome. Awesome. So what kind of skills did you end up doing in the OR?
Surgical Career Preferences and Work-Life Balance
00:24:51
Speaker
I think suturing no matter where you are is important. I think I got a lot less closing experience in gen surge, but in ortho I did a lot. So that's definitely, you know, knowing how to do a few different types of knots is definitely very helpful. And just, you know, that was the main thing I think for me. I never really drove the scope or anything except once I worked the camera.
00:25:14
Speaker
I did, like, when I was first assisting, I did, like, bovee stuff, like, cutting with the bovee, coagulating with the bovee, trying to think of what else.
00:25:28
Speaker
I worked at an outpatient surgery center a couple of days a week and it was just me and the surgeon. So in those cases, I was definitely first assisting and that was really cool because he really loved me. I got to do pretty much anything I was willing to try that he thought I was ready for within the procedure. He was like, do you want to try this? And I'd say like, yeah, sure.
00:25:51
Speaker
So I guess we'll basically use the bobi to help excise the light poma. He really just let me try within my scope, which was awesome. Yeah. I feel like mine is kind of similar to Gabi's. A lot of holding the camera, suturing, holding things, retracting. Also being able to, once I was a few weeks in, anticipate
00:26:16
Speaker
if I was first assessed, especially like what the surgeon was doing, if I've seen the case before, or like helping when they suture, like guiding, like holding the suture and everything, cutting things. Lots of cutting. Lots of cutting. I think a lot of it too for me, because I don't know, maybe it was just, it was just like, was the time of year and the students and like the surgeons, like, I think I got to use the BOBY like one time. I think I guess that myself into believing that like, we're not allowed to use it as students.
00:26:44
Speaker
Cause the surgeon was like, can you cut that out? And I was like, Oh, you're letting me do this. Like I was like, didn't even know, had such a different experience. But the other end of that as like a PA in the OR, especially in ortho cases, like a lot of the surgeons like expected me as I got through it to be like, you need to have the patient, like you need to be scrubbed and need to have the patient pre scrubbed and draped. Like how I like the whole thing draped with layers and like, you know, have the pads in the position and like, like, which is like what the PA is do is like, they basically.
00:27:13
Speaker
have everything set up and then also take everything down and close and do the dressing. So I think those are valuable things too. In the ORC that's kind of a lot of what the PA is doing in that environment.
00:27:27
Speaker
Man, you guys gotta do a lot of things. So let me tell you the saga of my surgical. So surgical, my first gen surge, I didn't do anything. Just cutting. And then I did OB at Stanford. And actually the residents let me close some portholes. I did a little bit of suturing. And then I came to ortho and my goodness,
00:27:53
Speaker
I was only with PAs, and they let me do so much suturing, not tying, depends on the surgery, and things like that, and it was so amazing. And then I did my elective and ortho, and same thing, lots of good things. A lot of things you kind of pick up, most of the things you pick up in the OR, especially
00:28:15
Speaker
even if you do one of them is OR, presence, your situational awareness, kind of what things to help with, where to position yourself and how to interact with, because it's all, it's a whole dance surgery. People are doing different things and you're trying to help as much as possible, but not get in the way and also remaining sterile and things like that. So kind of getting the lay of the land, being comfortable in that situation
00:28:41
Speaker
is a big skill that you kind of learn and kind of develop through surgery. It really depends if you have more than one surgical experience, because Gen Surge, five weeks isn't a lot of time to get really comfortable with it. But towards like my last rotation, having to do four of it, I was like loving the OR. I can live in the OR, I know exactly what to do, and I don't know how to hold myself in the OR.
00:29:08
Speaker
And that really makes a big difference in, if you even want to pursue being in surgery or not, is having that, being that comfortable in the OR. But that's cool that you guys got some good experiences, Serge. You guys want to do surgery now? I liked it a lot. I'm going to ortho surgery next. Oh man, I guess I got started off. Where Nick just was. And so is Abby. We were studying for you yesterday.
00:29:33
Speaker
We have very similar rotations. Yeah, our rotations have like lined up. It's interesting because I've had four surgery rotations.
Comparing PA Roles and Surgical Residency
00:29:45
Speaker
I've only had like two or three outpatient experiences and those have been far worse than my surgical rotations. My surgical rotations have been like so amazing.
00:29:55
Speaker
And I don't even want to step in the outpatient, just like, no, that's so boring. I don't want to be stressed doing charts and seeing 20,000 patients a day. So I'm definitely, surgery is amazing. And the thing about surgery too, is you feel like PAs are more appreciated and more needed because they really do first assist. They do a lot into OR and also with patient management, at least with the teams that I've been with.
00:30:23
Speaker
And outpatient, you know, really depends if, you know, sometimes they might have some autonomy, sometimes they don't, it really depends on where they're at. So it's, it's, it's a cool, it's a, it's a cool place to be in. But really, if you have a really bad search score experience, you probably will never want to step in the OR again. So really, it stinks how it's so dependent on your experience if you want to pursue that or not. But.
00:30:50
Speaker
It's funny that you say that because I feel like I had the exact opposite sentiment. Like I, somebody that I want to go into work, big surgery, but I felt like, um, it's an environment where we're really needed, but I never felt like we were really like there. We're not, we don't have really any autonomy compared to maybe if we're someone's PCP working in family medicine, we're not really making medical decision-making. We're not really.
00:31:12
Speaker
you know, leading anything, we're just kind of like, they're doing a job, at least in the environments that I was in. It was kind of interesting to see, like, people always talk about, Oh, over at this hospital, you know, we do x, y, and z, and it's different, you get better training there. But I always felt like we played a big role, but and also even in like the medical residents, like even senior residents, it's kind of like, I feel like it's on until they're out of training that they kind of are like, Oh, you guys do this. And this is how you can help manage patients. Because when you're a student, they're like, I don't know what you guys are here to care for.
00:31:42
Speaker
And the surgical PAs I interacted with were just kind of like doing whatever. They're like hanging out. I don't know, it's interesting.
00:31:49
Speaker
That is interesting because I've worked with three different surgical pH teams and they basically manage the patients and they just would let the surgeon know like sometimes their acid surgeon would you prefer this or this anticoagulation or dbt prophylaxis stuff like that but that's pretty much it and they would manage the patients obviously like post-op management isn't nearly so crazy as like traditional PCP management of things because you're just
00:32:18
Speaker
short-term, the patients are there short-term, you're mostly managing pain. They're mostly just, and if there's any crazy complications, the hospitalist manage them or the medical team manages those things. So really, I guess it really depends on what you are exposed to. I think in Connecticut, we're kind of spoiled because we have so much autonomy in different places, especially in the hospital. It's really cool to see them being so autonomous and
00:32:48
Speaker
I never really ever interacted with attending outside of the OR. You don't really ever see them outside. They just are doing stuff outpatient and living your life. So it was good to see that, see that for just PA scope awareness. Yeah, I think it's interesting. I don't know. I think it depends on like you're saying the facility and everything.
00:33:11
Speaker
It's also just different because you have a different experience when you're, you know, put into like an environment with a lot of residents and you don't really, you're like, Oh, I wonder, like, I mean, you know that you guys would just be doing that if they weren't there, but you're just in that environment. You're like, all right, well, I'm kind of the right ahead of stepchild, but I'm going to fit in however I can and, you know, try and get in some cases and.
00:33:31
Speaker
Have fun. So that reminds me, I forgot to talk about this. So for me, at least personally, being in the OR makes me appreciate not being a physician or not going down that route. Well, like, especially if you want to go into surgery, general surgeries, at least five years. And if you want to do more, it's more fellowship and they live at the hospital.
00:33:54
Speaker
I don't think they hardly sleep at home. They just live at the hospital. And even the surgeons, because they are the top dog, they have to be there if something is like they're always on call. They have to be there making the main decisions and things like that. There's no one else. There's people that cover day to day, but
00:34:16
Speaker
They're always on call and they always are doing surgeries. They're so busy and I'm so glad I don't have to deal with that. So it's another plus of seeing residents in action and for me at least, especially confirms that this is the perfect path for me becoming a PA because before PA school, you don't have that clarity. You just like abstractly think that, yes, you can change specialties and
00:34:45
Speaker
better. You can see the patients, baby, or maybe have some better, you know, quality of life or work-life balance, but you don't really understand it until you really get into it and start working. But anyways, that's an aside. Anything else you guys want to talk about? I was just going to say that it reminded me, I felt the exact same way, especially being at the hospital. And the work-life balance thing is funny because it's not like, I mean, depends on how much you like to work. It's not like we have
00:35:13
Speaker
It's not going to be perfect, but it's definitely better than that. You know, like that's relative to that. It's way better. And unless you need to, like, you really need to be like the final decision maker, you need to be the one with all the responsibility, which is like not always ideal. You don't always want that. Then it's definitely a great path to take for sure. The only thing I would say is kind of like you, we obviously don't have as many opportunities for continued like structured training.
00:35:42
Speaker
You know, like we can do fellowships and stuff, but it's still, I feel like it's still kind of like a gray area. So if you're like super into a subspecialty, you have to find your way into the right job and the right hospital network or state or whatever to really get enough training. But that's just kind of, you know, individual dependent and that's okay. I don't know. I actually prefer that because I, I really hate the idea
00:36:05
Speaker
I really feel like it's just my another rant. I really feel like residencies for PAs is just taking advantage of our cheap labor because you can do the same job
00:36:19
Speaker
for much more money and get the same training doing your actual job than residency program. Like some residency programs, I think like you might start out maybe a little bit more skilled in suturing and maybe in like robotic cases because you're, you specifically work with that, but you can just be trained with that.
00:36:40
Speaker
on the job training and that is what I personally like doing. I steer away from like I'm looking at jobs and steering away from people like residency preferred like no, I could do the same. I know someone that started doing the same thing I'm gonna be doing getting paid way more money working way less hours and getting the same training and things like that and not having to do that but that's just that's just my thing and me being having a family I don't want to
00:37:06
Speaker
another year of getting paid way, not getting paid that much and making way, working way more than I should have trying to get into a job that I really want. So that's just my, to each their own, I guess. Yeah, I totally agree. I think it just depends on hopefully finding the right, you know, place of work, right? One day it's actually going to deliver, Hey, we're going to train you for six months or a year or whatever. This is what our onboarding is like. And we're going to pay for these, you know,
00:37:36
Speaker
CEUs and whatever, like it's, hopefully that's the goal, ideally, you know, you don't want to have to, you know, forego that just to be able to, you know, get into a job or whatever. How's the studying process to
Success Tips for Surgical Rotations
00:37:49
Speaker
you? Do you guys felt like you had enough time to study for the end of rotation? Or you felt like you were just cramming towards the end and didn't do as well because of that?
00:37:58
Speaker
I personally like starting in rotations, I said off the bat, I'm going to get the assignments that we have to do out of the way within the first two weeks so that I have the rest of the rotation to study. Surgery was very difficult because you're physically exhausted by the time you get home. So even after finishing those assignments within
00:38:22
Speaker
the two weeks, getting myself to sit down and study something after standing up. Some days I was actually like, what was my record, Nick? Like six or seven surgeries in a day. I was standing for like so long. I could, I limped to my car. I was like, I have to ice my feet and go to sleep. I can't
00:38:44
Speaker
study every night. So I ended up picking and choosing my shorter days, which some days they truly didn't have anything else for me to do. Their procedures started at 7.30 in the morning. And then if I was done by 3.30, they'd be like, okay, take off. So then I come home and that's when I would do my studying. But I would say the bulk of my studying happened the weekend before.
00:39:09
Speaker
And the actual study guide that they give for the EOR exam wasn't all that much material, in my opinion. It seemed manageable compared to POM exams that we had studied for in the past. So that's how I approached it. Yeah. I mean, I had a very different experience. I was only in maybe one or two cases a day. So I would just kind of like sit in a library and study a lot.
00:39:35
Speaker
And I would say, I would agree with Gabby in terms of like the number of topics, maybe the only difference from like POM or clinical medicine or whatever, you know, exams you have throughout the years, maybe you have to have a little, a very, very good understanding of every topic, like maybe deeper than you would in didactic gear, because they really, at least for surgery, you really need to know your electrolytes and really need to know perioperative management and obviously your GI stuff. So that's like the main difference. So at least I was able to kind of study every day just cause I wasn't, you know, in the OR 12 hours a day. So.
00:40:05
Speaker
definitely had its benefits. I think mine was similar to Gabby's. I'd be in a lot of surgeries, so I didn't really have time to study during the day just because it was so hectic and you never really knew what your schedule was. So I would try my best to study. I would take a little break when I got home just because I needed to get myself rest a little bit, relax at dinner. And then I would try to study at night. But it was also hard because I would also find myself having to study
00:40:33
Speaker
for the next day. I would also be studying for, if I got asked any questions, I'd be studying for the surgeries that were the next day as well. So I do think a lot of my studying was not really crammed, but I think a lot of my focused in-depth studying was the week and the weekend before. I did find the exam to be pretty difficult for me. I think it was also just because it was my first end of rotation exam as well. So obviously, it's different than the exams that we've had throughout the year.
00:41:01
Speaker
But yeah, it was a good learning experience. I think next time I need to try to like study a lot right off the bat before I start to get really tired at the end of the five weeks and the four or five weeks. So I kind of spread it out a little bit better.
00:41:16
Speaker
Yeah, but that's so true that in the small amount of time you have when you get home, you might have to be preparing for surgery the next day. Hopefully that surgery is something that's gonna be on the list that they give you for your EOR exam, but in my case, a lot of it wasn't. And I think for me at least, as I started seeing the same procedures over and over, because I was fortunate enough to be in so many surgeries,
00:41:44
Speaker
I had to I didn't have to prepare anymore at night, unless there was a new case that they were like, hey, check this out, you know, the night before. So because I hadn't seen it yet. But yeah, at least for the first, like, three weeks, you're basically studying for the day, the next day, and hoping that it overlaps with something that's going to be on the exam.
00:42:09
Speaker
I think like I said too, Gabby and I didn't really do the rounding and stuff. I know I was talking to one of my other friends, she was in ortho, so it was a little different, but still like surgery. She was saying like how much she learned from doing the rounding and she would watch like the residents in the PAs, they would present cases and stuff like that and go in more.
00:42:28
Speaker
like more in depth with electrolytes and like diverticulitis and stuff like that. So I feel like that would have helped more with my studying because you can relate it to a patient. You can be like, oh, I remember this case when like the physician talked about this or this patient that had this happen. I don't know. I felt like that would have helped me more solidify the information more. I mean, I liked how much surgery I got to do and not as much rounding, but I think it also would have helped in that sense.
00:42:54
Speaker
I think it definitely did for me. And like I said that before, just the fact that you have to be responsible for like, I need to look at these one or three patients labs every day and track them and track their vitals and everything and like, understand what that means and be responsible for just telling a chief resident about the patient definitely helps reinforce that. And I know obviously you guys will get that more in the rest of your rotations, but definitely does help.
00:43:18
Speaker
You guys are the pros. I kind of limped by on my rotation. So that's great to hear you guys is what you guys did. And it's not all pretty. A lot of the times you're just going to have to like
00:43:33
Speaker
do as much as you can. Just hope that's enough because you just don't have enough a lot of time and you don't have a lot of energy to do some of that. So you just have to do the best you can. So that's awesome. You guys made it. You guys are making it. That's great. Um, any last advice you want to, you know, impart to whoever who listens to this podcast about surgery or clinically or in general rotations or anything?
00:44:01
Speaker
I would say, you know, just try and be confident in what you learned in your didactic year, because it might not be 100% of what you need to be successful in the rotation, but you're definitely more than prepared. And I think you'll definitely start to see that when you interact with other students from other schools, when you're, you know, given responsibilities, you know, you're able to pull from the stuff that you've learned and understand, start really applying your knowledge to things like labs and imaging and just, you know,
00:44:27
Speaker
understanding patients here, you might not have studied GI stuff for a year, but you have a great base, I think. And even though PA school is so compressed, I think, you know, be confident that you were definitely given a good base of knowledge to start with. And just, you got to kind of like sprint for five weeks and put your best effort forth, like, have a good attitude, because it sometimes could be, you know, provide you with great connections for a job, you know, you never know.
00:44:51
Speaker
I know that's a really good point. I think if you said it, they were like, you can do anything for five weeks. And it's true. I think one of our professors said it too. But I've been telling myself that for like every rotation, like you can do anything for five weeks only when there's a light at the end of the tunnel, you can make it.
00:45:09
Speaker
Yeah but yeah just having that like attitude like going into everything with an open mind and then for me I feel like I get very nervous so what I just had to keep telling myself was like fake it till you make it. Not to the point where like you're going in cocky about each surgeries but just being like I am capable to be here. I'm gonna act motivated, I'm gonna act excited even if it wasn't something that I want to do maybe it wasn't a case I wanted to do
00:45:32
Speaker
It's always just good to go into that attitude and just knowing, you know, it's going to be a good experience. You can make good connections. I can get through it. I'm going to act like I'm capable, even if I'm very scared, which a lot of the cases I was, especially scrubbing in for the first few times and walking into an OR, not knowing what I'm getting myself into. So I think just having a good attitude for any rotation is very important.
00:45:54
Speaker
Yeah, going off that just listen to your classmates who have gone before you to the same rotation, but also go in with as open of a mind as you can because
00:46:06
Speaker
We've had two rotations so far, and even in that short period of time, people have had such different experiences at the same place. So just because someone says, oh, don't work with them, they're so mean. Like, I think Abby said this, that someone that she was kind of told was really difficult in the OR ended up being one of her favorite people to work with. So just...
00:46:34
Speaker
Allow the rotation to make its own impression on you. Don't go in with an idea that you hate it already. And my only other advice is trust your gut. If someone asks you a question and you think you know the answer, say it. Because there were times where I was not 100% sure and then ended up being right.
00:47:01
Speaker
but I didn't say it until, and then he was like, okay, go look it up after. And I knew it. I just didn't say it because I was nervous. So they prepared you trust your gut and take your best guess because you're there to learn. And if you're wrong, it will be burned in your memory forever. And you learn best by probably answering things incorrectly. Right. Well, that's, I feel like that was a pretty,
00:47:27
Speaker
good, some good knowledge imparted to whoever listens to this. I think the overall take all is the war can be intimidating, but it's a habit. It's doable. It's, it could be even good. If you have good experience, when you even like surgery, which is, I didn't think, I didn't think in a million years, I'd want to do surgery. But now I'm like, yes, that's what I want to do. I want to be in the OR. I want to manage patients in the hospital. So.
00:47:53
Speaker
That's really cool. Well, thanks so much, guys, for taking your time out to talk with me. And I'm glad you hopefully you've enjoyed it. And maybe we'll even see you guys in later episodes talking about other rotations and other adventures. That'll be really awesome. Thank you. Thank you. It's so fun to be on. I know. No problem. Yeah, always a good time next year. No problem. OK, talk to you later. Talk to you guys later. Bye bye.