Thoughts on Surgical Posting

Hi :) hehe

I know I skipped my 2^nd year in medical school posting but listen, I spent my whole 2^nd year in my own house,,, so I don’t think I have the rights to say anything about it. I think I spent another 4 months with my online class during clinical year and finally get to spend 2 weeks on my surgical posting! It was supposed to be 1 month in the hospital, but lockdown happened, so we only have 2 weeks face to face session.

We were supposed to have 2 months for each of our clinical posting (O&G, Surgery, Internal Medicine, Paediatrics), but since we were having our lockdown, pkpp and all the pkps we have, we have to spend 1 month of each posting…online...and another 1 month face to face. (kinda shitty but no choice)

I really don’t know how to actually make this post interesting, but please be reminded that I only have 2 weeks in the surgical wards.

Firstly, I’ll talk about the things we need to do in surgical posting. I didn’t know anything about clinical year, like any single thing about it, so I asked my senior and she gladly sent a bunch of text about clinical year things. It was such a nice gesture but that’s the best thing about here. Every seniors will try their best to help their juniors, very sweet. I listed out the main thing that you need to know about clinical year on my Trello board here: https://trello.com/b/b0MXdck8/clinical-year

1. Assessment
• Case write up
• Instead of needing to submit 5 case write up, we need to submit 3 cases since we have only 2 weeks in the ward. This was so hectic because by the time they announced we can't go into ward anymore, I only have 2 cases. Let's keep how I get my 3rd cases to myself, ok? 
  
  
• Case write up is the cases you need to write about your patient that you clerk and all the findings you get during physical examination. All the findings, investigation, management and discussion are needed in the report. Some doctors will asked you to write it by hands, but my doctor told me that we can just type it instead :) 
  
  
• My cases: Breast carcinoma, Acute pancreatitis and Rectosigmoid carcinoma
  
  
• Logbook
• This is the only thing that will ruined your motivation if you didn't get lucky </3
  
  
• In this logbook, you need to get doctor's signature for observing, assisting and performing the procedures, signatures for observing in the operation theatre, observing the endoscopy procedure and signature for your clinical presentation. Oh, and also the clinical ward round.
  
  
• There's a lot of procedures you need to observe, assist and perform, and it was a fun thing to do probably if you have 2 months. 2 weeks is a struggle to fill in everything, but still a fun thing to do especially if you get to perform it by yourself!
  
  
• One of the procedures was wound dressing, and the house officers asked me whether I would like to perform it or not,,,, i mean,,, who will say no... So I did the wound dressing on the patient, nothing difficult because it's a dry wound (gangrene). If it's a moist one,,, I'll feel the pain together with the patient while cleaning it.
  
  
• Another house officers from the other ward offered to teach us blood taking too (well, to be exact, I asked him to help us). Since we only see the video of venopuncture during our online class, we practiced it among ourselves before taking the patient's blood, under the house officer's guidance.
  
  
• All of the house officers here were so nice to us in the whole 2 weeks of our surgery posting, really grateful for their help :(
  
  
• End of posting exam
• This is also the most hectic part. We weren't supposed to have this EOP session because we don't have much time, but all the doctors still do it anyway. 
  
  
• My doctor told me that we won't have EOP, just discussion for our case write up but at the end of the session, he said that this is our EOP session... I finished my EOP without knowing I did my EOP :)))
  
  
• EOP is basically a discussion and questions (viva) of your case write up. I don't think I heard anyone given a random cases or any short/long cases. Probably because we're in a pandemic, so no unnecessary patient contact is required.
  
  
2. Ward round
• You need to come to the ward that you're designated to go on the day. So just go to the ward of your particular team, clerk some patients earlier incase the doctor asked you to present the case, and get your ward round signatures for you ward round attendance. Sometimes they will started the ward round around 8am, some will be around 7.40am. I think it depends on the medical officers.
  
  
• My advice will be for you guys to go at night, look at all the patients on the board, clerk the patients and read + make notes about the disease they're suffering from. I wish I can do that but it's too late :( From my opinion, by doing this, it'll be better for you to learn the cases and at the same time knowing the management of each patient. 
  
  
3. On call
• On call!! Okay to be honest, it's not as fun but the night vibe was so different compared to day vibe. (Although, if I finished my on-call attendance, you won't be able to see me in the ward anymore.)
  
  
• There will be a few procedures in the ward and sometimes you will be able to observed the emergency procedures made by the doctors. 
  
  
• Cons: tiring eventho just 8pm-12am. (imagine me in o&g posting for 7pm-7am?? ill be dead)
  
  
4. Seminar
• Instead of having to listen to the lectures, you need to make the lectures among yourself. You'll be divided in a group and presented it infront of your classmates. The only important advice here is make sure you use the correct source, its not just for good impression infront of doctors, its to make sure your classmates don't get the wrong information.
  
  
• Use Bailey and Love, Talley O' Connor, Browse and Schwartz's Surgery. 
  
  
• Extras: CPG, Uptodate
  
  
• Don't use Doctrina perpetua as your references. Refer to it for yourself but if the doctor asked you what did you use for your reference, never ever said "Doctrina perpetua". (Idk the reasons so dont ask me,, too many surgeons got mad at the name of this book).
  
  
5. Clinic
• You have your own schedule for this clinic in a group. Basically, just listen to the surgeon's, and answer the questions from them? I only get 1 experiences,,,, im sorry ill update on my next posting's clinic.... (covid things)
  
  
6. Final examination
• Consisted of Multiple true and false (MTF), Single best answer (SBA), and OSCE (2 questions). 
  
  
• Basically....do your past year ;)

The best thing about being in this surgical posting will be about getting to observe the procedures on the OT room! Most of the time the surgeon will ask us about anatomy and the landmark, and most of the time we can't answer it (sad). That's okay, you just learned it when you finally got back to your room. I just love wearing the scrubs, wish we can wear it during the ward round or around the hospital </3

That's all the important thing that I can think off. It's so so upsetting on how I only get to have 2 weeks experiences in the surgical ward. I genuinely wanted more time to actually know all the common diseases and management for this patient, and also variations of clinical presentations on different patients. Make your next 1 month (or 2 months) posting worth it.... I'll try to learn from my mistake that I realised and fixed it on my next clinical posting, Internal Medicine. 

Summary:

• Generally:
• Abdominal pain
• Hematuria
• Per rectal bleeding
• Appendicitis
• Breast cancer
• Colorectal cancer
• BPH
  
  
• Interesting things:
• Drug-induced pancreatitis 
• Get to feel the positive signs of most diseases
• Get to feel the breast tumor
• Seeing one of my clique scrubbing in for a surgery!
• Get to smell the OT room (omg sorry)
  
  
• Pros:
• Short on-call (for student of course)
• Get to see a lot same cases with almost the same presentation so you cant think of the provisional diagnosis
• The surgeons are all nice in the OT room
• Sometimes you get to see the operation up close :)
• Continuity of care, so you can talk a lot more with your patient
  
  
• Cons:
• Probably just the fact that we didn't get more time there
• Limited hands-on-learning because its covid and can't get too many students in a ward/room
  
  
• Study resources:
• Mostly, uptodate because easier (dont do this)
• Bailey & love
• Browse's Introduction to Sign and Symptoms
• Talley & O'Connor Clinical Examination

Extras:

Going to the ward to find patient for my case write up was so fun! This one time I was reading about this one patient with Acute Pancreatitis (I didnt take him as my patient because he was there for just two days), and one of the nurse was looking at me. I thought I disturbed her work so I stepped aside, and she literally went to me and reached for my hands. I was so scared that I did something wrong, but she just asked about my henna and complimented on how my nails looks so pretty. Appreciate that, and I won't stop wearing henna. 

And this other time, me and my friends went to the endoscopy room for logbook purpose. There was like 10 procedures?? And then no one saw me at the endoscopy room anymore. (jk). But the endoscopy room will be so informative if you read first beforehand. One of the surgeon there taught us about what they were trying to find, how do they ligate the band and what causes esophageal varices. 

I think that's all for this post. I will try to write more on the next clinical posting, do pray that we all get to go to the hospital again since we might get vaccinated next week! Sorry for not updating as much, I don't think I have anything else to post over here and over youtube. 

Stay safe everyone, :)

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