Saturday, June 22, 2013

Surgery Posting (Pre, Posting and Post)

Hye to all,

I am sharing this to you, hoping that you will gain benefits from it :) Hope it is not too lengthy, I had tried my best to simplified it by subdivided the to-do-things into pre, during the posting and post with several hyperlinks. For those who wish to read more, click on each orange-coloured wordings. There will be hyperlink that link you to the page with more explaination. Enjoy surgical posting! It was fun..

1. Pre-posting preparation:
  •  Register for BMJ learning, Best Practice and also BMJ Onexamination. It's very useful and complete with updated information. This is very helpful for TBLs and also your case write-up.
  • Read about this topic before you enter the first week of surgery posting. However, it's better if you managed to read all the core topics in the guidebooks but then don't forget when you are reading this, you only have a few more days before the fist class starts on next Monday ;)
    • thyroid 
      • know about the history taking for a lump, make sure you are familiar with this just as how familiar you are for the pain history taking template! (SOCRATES or DOP C SARA) 
      • I was so sad that I only mastered this lumps history taking template in 5th weeks :( So I hope you guys know this even before the posting begins
    • breast
      • lecturers will show videos of some PE during the first week.Get the video from the lecturers and u guys can try to produce a checklist from the videos. (very short, only 20 mins). However, don't worry, lecturers in hospitals will teach you on how to examine (e.g. breast examination) as you go along the posting.
    • abdomen
      • Nothing much different from what we have learn from pre-clinical years. Just a few reminder from me:-
        • bend down your body until it reaches the same level with your hands during palpation, percussion..
        • percuss spleen and percuss the Traube's space, dullness in Traube's space indicating splenomegaly. (I never did this two steps during my pre-clinical years) (^_^)???
        •  always palpate the kidney using ur dorminant hand. During ballotable kidney, dominant hand should be feeling from the top, push the kidney from behind :)
 2. During the posting:

  • Hospital Sri Manjung 
    • OT session -
      • appendicectomy will always be at night because it's an emergency case. (but not all the times, people can get appendicitis in the morning too >.<)
      • attend the on-calls, this is the time when I learnt most! I don't know if you believe me or not, you can actually learn a lot by just talking, or following HO or MOs.
  • In the wards:
    • Always ask MOs or HOs questions. If you did not ask questions, they will assume that you know everything and you are not learning. Dr. Lidya, one of the MO there told me this. For MO, Dr. Ravi is really good. I had an experienced following him during the afternoon ward round. That time, there was only me and a few HO and he taught me lots of things. He taught me how to read the x-rays, taught me about investigations done for cholelithiasis patient, SIRS and sepsis. He also teach me step-by-step of the procedures for appendicectomy.
    •  Always follow the morning ward rounds, Mr. Rizal will speak loudly to the crowds there, so that we, the medical students can listen and learn.
  • In Hospital Army Terendak
    • SOPD
      • There will be not many patient here so you can present every case to Dr. Ngoo. Sometimes, you may even do the PR with the permission from the patients and of course, lecturers! It was a precious experience! Be proactive and do not miss any chance to LEARN! Here in Terendak, you can see lots of protoscope as well. So make sure you know what is that first :)
    • Blood taking
      • I started to know this when seniors told me in the 6th week. Hence, I spent most of my 7th week times in blood taking room taking blood from the real patient. This is another confident booster experience. Ask permission from sister and they will let you do it! Read how many ml you needed first before you start taking the blood! :D Don't poke the patient too many times because of our ignorance!
    • Wound dressing
      • Go to the wound dressing room and learn from Sister Khaliza. She is very awesome and she is very willing to teach us! She even teach us how to insert and remove the Foley's catheter, teach us something about paeds! Know her and you will start liking her.
    • Imaging department
      • Go there and learn about CT scan, Doppler Ultrasound and also Ultrasound. Dr. Aliuddin was really nice. Go in and see what's the gall bladder looks like when there's a stone. Thickening of the wall of gall bladder? Dilated cystic duct? Dr. Aliuddin will let you know and see it by yourself! This will definitely help you to learn about investigation.
3. Post - posting:
  • EXAM?! As for me, I got Mr. Ahmed Awil Adam as my examiner and of course, I experienced several nights of palpitations! 
  • Actually, only after the exam, I realized that there was no need for stress and nervousness. Just do as usual. Remember this, GENERAL EXAMINATION is a must except if the examiner tell you not to do. Otherwise, you have to do it. 
  • Don't worry too much if you get Mr. Ahmed as your examiner, he is helpful and nice.
  • Do not be too checklist-oriented. If the patient was unable to answer your question, proceed and later on during the history taking presentation, tell the examiner that the patient was unsure or unable to give the info. I did not do this, I was so nervous and stucked when the patient was unable to give me the exact duration for her abdominal pain. So, i hope u guys will know what to do after this.
  • Do not apologize too much to the patient as it will make your confident level lower. -advice from Mr. Ahmed to one of my groupmate.
  • During the exam, you will start off with history taking, then PE and at last the examiner will ask you about the provisional diagnosis, differential diagnosis and also the investigations that you can do.
  • Don't stress up when you get a difficult case, what the examiner matter most is how you approach the case. For e.g. if you got a case with a lump(that you never see before), what will be your aproach? Of course, you will do the history taking and PE for lump, then make a logical provisional and differential doagnosis. Lump at the muscle, maybe you can suspect sarcoma. Lump in artery, perhaps aneurysm! 

*I guess that's all. If you have anything, you can still ask me and I am willing to help.  I wrote this based on my personal experience so sorry if I am wrong. All the best to you guys and surgery is really awesome. You will enjoy it. Did I missed anything? Lecturers in surgery, they are awesome and SPECIAL. They are so passionate to teach U! Grab this opportunity to learn from them. :D


imran siddiq said...

Hello there.. Thank you for sharing, I am imran going to third.. I just wonder how do I start my study,? I am rather clueless of where to begin.. Too many books but no direction

Evie Evelyn said...

Hi Imran,

you are most welcome! I think maybe you can start to read on history taking and physical examination in the "Browse Introduction to Signs and Symptoms"? It will help you a lot.. :) and also, try to ask our lecturers for guidance as well ya! I am sure they r willing to help.