by Anne Dang, BHSc (Hons), BHSc. PA McMaster PAEP Class of 2011
General Surgery was definitely one of the more difficult core clerkship rotations during 2nd year of PA School. You get a different experience depending on which hospital you get placed with. For instance, in a rural hospital setting where you are the only learner, its not uncommon for PA clerks to perform as first assist to the surgeons. In crowded learning centres, you may compete for teaching time with other medical learners (fellows, residents, medical students).
In the OR: scrubs. Make sure you have your “scrub” session (a session which teaches you how to scrub in) before you step into the OR.
Clinic: business casual, or wear a white coat over your scrubs. This also depends on your attending.
What Else to Bring
2 Pens, one for yourself, and one for your attending in case they ask to borrow one and dont’ give it back
A notepad to write down clinical pearls as you go through the day (little “pearls” of great tips and advice from your preceptor)
Pager: you should receive this on the first day, or at orientation for surgery. This will beep whenever there is a consult. On it an extension phone number or message for you to respond to or call back.
Walking List: This is a printout list of names and location of all the patients under your attending physician’s. It is also an easy way to keep track of known issues. Print out a new one everyday
Smartphone: Some surgical teams communicate solely through text/bbm instead of the paging system. Plus it doesn’t hurt to have some medical apps you can make quick reference to.
Drug Handbook: Tarascon Pharamacopeia is the best drug dosing book thats most commonly used by residents, medical students, PAs and PA students! Great quick reference guide.
On-call surgery is where you may do the most learning. Your resident on call will tell you to go see a “consult”. This is another service who has a potential patient issue which may require surgery. Your job is to determine whether we can operate on this person or not. A lot of the surgery calls you will get are from the emergency department. Take a detailed history, do a detailed physical examination, make sure you have all the necessary information from bloodwork and imaging, then before you call your attending to review the case with them, formulate an assessment (hypothesize a diagnosis, and potential differential diagnosis) and then a plan. Even if your diagnosis and treatment is incorrect, its good to practice in an environment where learning is encouraged.
Medical vs. Surgical: Learn the difference between a “medical issue” and a “surgical issue” (e.g. If you were to a consult a service on a particular problem, would you contact Internal Medicine (“can we fix it with drugs?”), or Surgery (“Is it something we can operate on?”)
Anatomy & Physiology is essential in a surgical setting. Before you go into any OR procedure, ensure you prep by reading the anatomy (structural anatomy, functional anatomy, blood supply, nerve supply, lymphatics, surrounding structures). For instance, not all bariatric (weight reducing) surgeries are the same. Anatomy topics in General Surgery: Stomach, Pancreas, Liver, Biliary Tract, Gallbladder, Colon, Small Intestine, Anus, Rectum, Peritoneal Cavity, Kidneys (not in detail, since Urologists operate on the kidney).
Teaching Sessions: Most teaching hospitals provide sessions to the clinical/PA clerks about common surgical topics. Its encouraged that you attend these academic sessions.
Common Surgeries in GS: An example of preparing for the common surgeries in general surgery is: go by organ system, picking the most common surgical procedure for that organ and studying that (e.g. Organ: The colon. What can go wrong? Diverticulosis develops into diverticulitis, with risk of perforation into the peritoneal cavity or create a fistula with a nearby organ. Partial colectomy, removal of part of the colon may be required.)
Common Surgical Procedures: A basic textbook or handbook is good for this if you are not planning a career in surgery. Know common procedures (name of the procedure, what anatomy is altered, and how the procedure fixes the problem).
Ward Management: Ensuring that patients have stable vitals pre and post-op, are passing gas (flatus), making bowel movements, and good drainage from the JP drain. Be familiar with your patients, what their active issues are.
MPASA is the Student Association for McMaster's Physician Assistant Education Program in Hamilton, Ontario, Canada.