General Surgery Clinical Posting: Life of a Year 3 Medical Student

Sorry for the hiatus! I’m back with a backlog of posts about the rest of the postings that we did in Year 3.

What General Surgery Clinical Posting is Like

For General Surgery (GS) posting, we have a mix of OT (operating theatre), clinics, ward rounds, and tutorials.

OT: As with the other surgical specialties, you have the chance to don OT scrubs and behold some fascinating (or tedious) surgeries. This all depends on how excited you are about surgery. I personally feel that I’ll be a lot more pumped up if I were the one actually doing the surgery rather than watching on the sidelines.

Clinics: Just like Ortho, GS clinics are divided into subspecialties (see the Subspecialties part below).

Ward rounds: The rounds can be efficient or pretty long depending on the patient load. I remember on the first day of GS posting, the HPB (Hepato-Pancreatico-Biliary) team rounded for more than three hours.

Tutorials: There were quite a lot of tutorials scheduled during our GS posting. But again, this might vary depending on the hospital you’re attached to.

BONUS – Calls: Calls (or working overnight in the hospital) are not unique to GS. In fact, I did try calls in IM and Ortho as well. GS is just the posting where I did it the most number of times. FYI this is not part of our curriculum, you literally ask the doctors yourself if you want to stay for call. Sleep is too valuable for me to stay all the way, but I do have hardcore friends who stay the whole night (and then continue with posting the next morning on minimal to no sleep).

Subspecialties in General Surgery

Here’s a quick note: similar to Internal Medicine, General Surgery is further divided into subspecialties. While all trainees first undergo General Surgery training, they eventually subspecialise and develop more in a particular area of surgical expertise.

At our hospital, we were exposed to six main GS subspecialties:

1. Hepato-Pancreatico-Biliary (HPB) Surgery
2. Upper Gastrointestinal Surgery
3. Colorectal Surgery
4. Breast and Endocrine Surgery
5. Trauma Surgery
6. Vascular Surgery

There are of course various other surgical subspecialties, including but not limited to:

• Thoracic Surgery (could be grouped together with Cardiac Surgery as Cardiothoracic Surgery)
• Transplant Surgery (could be grouped together with HPB)
• Surgical Oncology

Other surgical specialties that are usually not classified under GS include:

• Cardiothoracic Surgery
• Neurosurgery
• Orthopaedic Surgery
• Plastic, Reconstructive and Aesthetic Surgery

The Highlights of General Surgery Posting

1. Appreciating the clinical signs. GS can be quite visual (and tactile)! For instance, if a patient has a breast lump or a hernia, the mass can be both seen and felt. These are relatively common presentations that we have to be familiar with. There are also pathologies that you can appreciate on imaging, such as CT scans.
2. Seeing patients. I’m infinitely grateful to all the patients who graciously allowed us to examine them. It is truly them who contribute the most to our learning. Seeing patients also brought some memorable moments, like holding a patient’s hand and offering reassurance when she teared up before her breast surgery.
3. Learning about the GS conditions. As a medical student, more of the focus is on having a solid understanding of the key conditions and concepts, rather than the actual intricacies of surgical procedures. This is just as well, otherwise the amount of content would be overwhelming. As with other areas of medicine, I found studying the various conditions to be very enjoyable.
4. Joining GS calls. As mentioned above, calls are not obligatory. Often when I stay for call the HO/MO (junior doctors) are like what are you doing here lol pls you have better things to do with your life. But there were definitely memorable moments on GS call.

On my first call, I deliberately made sure that I was with the “active” HO. So I ended up in the ED. Five minutes in I saw a lower GI bleed (the doctor inserted a proctoscope and blood gushed out from the patient’s anus). Ten minutes later I was holding a (heavy) patient in lateral position while the doctor inserted a flatus tube to relieve her abdominal distension. Then there was some trauma case from a road traffic accident. Guy was wheeled in with a cervical collar and the doctors were trying to ascertain that he didn’t have any spinal injury.

Okay but that’s about as exciting as GS got… You’ll still spend a lot of time in mind-numbing tutorials, sitting in clinics, or poring over lengthy notes.

The Lowlights of General Surgery Posting

1. Confusion on anatomy. I feel like surgeons really need to have such a firm grasp of anatomy. And not in the ‘textbook’ sense, but how everything looks inside the human body. There was once I was watching a laparoscopic anterior resection (cutting out the rectum). I had absolutely no idea what I was looking at. Every structure was just a pink blob and I would not have been able to name a single one. (I mean if I see a blood vessel I definitely know it’s a blood vessel, but can only guess at which exact artery it is.) Which is both terrifying and humbling, because I realise there’s so much I don’t know. And there’s a whole new world and specific set of skills you have to develop to do surgery.
2. Not enough time and brain space. Okay so if I had unlimited time I want to have a really good grasp of anatomy like the guy from AnatomyZone. I also want to delve into more stuff like learning more about different types of surgeries and surgical skills. But, alas, time is so short and there’s so much content—including from the other postings—that even just focusing on the core competencies will keep you more than occupied.
3. Not that much excitement in the OT. You’ve been standing for four hours, you’re freezing (OTs are cold), you have no idea what you’re looking at—how exciting can it be… Hahaha okay but in all seriousness, I do feel that it will be a much different experience performing the surgery than watching at the side.

Overall Impressions of General Surgery as a Specialty

To make it more fun let’s break down some stereotypes:

Stereotype #1: Surgeons don’t need to use their brains as much (vs Internal Medicine)

Because I want to do something surgical, I’m always arguing with my friends who want to do Internal Medicine with the reason being they want to “use their brain” lol please as if surgeons don’t need to think.

That aside, I found the learning to be as intellectually stimulating as any other field in medicine. As with any medical specialty, there is a massive amount of content to master. We, as medical students, have barely scratched the surface. Surgeons also have to manage their patients and that involves substantial thinking and brainpower and medical knowledge.

Stereotype #2: Surgery = less interaction with patients

Surgeons do follow their patients both pre- and post-operatively, and they run clinics too. So definitely there is patient interaction.

Stereotype #3: Surgery is exciting

Surgery can be exciting if you’re thrilled about it, but it may be less than what some medical dramas portray. Read above—if a surgery last five hours, there’s probably more tedium than thrill. Also there’s so much more to patient care than performing surgeries in the operating room. Not to mention the myriad of administrative duties.

(BTW I haven’t actually watched any medical shows before, so please recommend good ones! Or medical documentaries or films will be even better.)

Stereotype #4: Surgical specialties have a malignant culture

Regarding this, I can’t say for sure since I haven’t yet worked in the field nor experienced it as a trainee. The workload is definitely high and the stress can be intense. We’ve all heard some horror stories. But honestly the doctors I’ve met have been really nice. And I guess a ‘culture’ is not set in stone—it can evolve and is also dependent on the place and the people.

Quick note!

We’re often told not to judge what General Surgery and other surgical specialties are like based on the medical school posting alone. It will be a completely different experience actually working and training in the field. So keep an open mind, and if you’re interested in surgery, don’t let your experience in the posting deter you.

ONE Example of Something You Might See in General Surgery

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