Do You Have to Do Surgery in Medical School?

Gone are the days of the 70’s when a student could wander into surgery, open someone up and have a go at moving parts around.

These days? Med students don’t do any surgery in med school. They only learn the subject theoretically.

The reasons why that’s the case, what they actually do and how they might gain more experience? Those are all subjects of this article. So read on if you want to find out more.

Do Medical Students Perform Surgery?

As a patient expecting surgery at a University teaching hospital don’t worry. Medical students are never expected to perform surgery. You’ll only ever have a specialist operating on you.

Disappointing for us but great news for you…

Here are the major reasons why:

• Country/state laws: you can imagine the legal issues that could be caused by an inexperienced med student attempting a tricky surgery for the first time.
• Hospital regulations: independently of laws, hospitals might have their own policies as for what is and isn’t allowed in the operating theatre.
• Internships: most “hands on” experience for beginner surgeons is usually reserved for the internship years in the US. Those are the first couple of years out of med school (PGY1/2) where medics start to specialize.

In Bulgaria where I’m a student (International – English speaking course) it’s the same. I’ve never even got near a patient in the operating theatre. But more on this later.

Do Medical Students Learn Surgery?

Surgery is a core subject of an MBBS program (typical medicine curriculum). It’s one of the main “rotations” we do in our later years of school, along with internal medicine, paediatrics, psychiatry, family medicine and obstetrics and gynecology (OB/GYN). 

At the time of writing I’m “doing” it alongside OB/GYN and family medicine. “Doing” because everything is somewhat restricted by the Covid-19 pandemic…

So while we’re not allowed to perform surgery per se we are expected to participate. 

In the US a surgery rotation usually happens like this:

• 6-8 week program
• Observing or discussing 5-8 surgeries per day
• Finishing with a “shelf exam” (surgery-based exam)

For international medics studying in Europe like myself however, it works a little differently. We do a couple of years of it (only theory). And we have an exam at the end of each year.

So the way surgery is structured depends on each individual med school.

What Do Medical Students Do On A Surgery Rotation?

Just like there are differences in how surgery is taught, there are also variations in what med students get to do.

Generally (even at the worst med schools) students will at least get to do patient rounds. This involves observing patients before or after they come out of surgeries. Maybe taking histories and presenting or reporting back. 

What might be different is contact with the operating room. Some students might get a lot. Others next to nothing (I’m one of those).

Here’s what most students should expect however:

• Scrubbing in: this means preparing for observation in the operating theatre. You’ll have to wear a face mask, surgical cap, sterile gown and gloves etc. Then stand by the patient helping the surgeon or watching the procedure. TeachMeSurgery.com is a great website that explains how to do this.
• Basic assistance: helping prepare the theatre, positioning equipment, driving laparoscopes (or the cameras), cutting excess of sutures etc. Maybe even making incisions or stitches (if the supervisor is really generous).

The extent of both varies though. It depends on how busy theatres are. As well as how willing surgical senior residents (specialists) are to help!

Some students? Only get to stand in the corner of the room. Or watch from a TV monitor in a different room.

Note: retraction and suction are other common activities students claim to get to do on surgical rotations. I haven’t personally met any that have done these however.

How Do Medical Students Practice Surgery?

I mentioned before, in my article “how do medical students practice surgery”, that the usual way students get to practice surgery is by doing so at home or via YouTube. That really is the most common way!

Obviously, before any procedures though, we have to learn the theory. That means a lot of book work. Studying what kind of diseases call for different types of surgery.

There’s also the option of shadowing surgical specialists. Something I’ve done myself in orthopaedics during a short summer placement. 

You can now even do virtual shadowing too. Google around for streaming opportunities. They’re becoming much more of a thing.

Perhaps the best way to practice surgery as a med student though, considering the aforementioned limitations, is to impress your teacher or senior. Do that enough and they’ll likely throw you more opportunities to observe, scrub in and assist in the ways I talked about above.

Here are some great ways to do that:

• Be on time or early for rounds: learn about your patients, what their cases and be prepared (even if not called) to report on them.
• Be personable: get to know your patients. Maybe they’ll put in a good word for you and open up an opportunity come operating time.
• Take notes on your phone: you can easily pull it out of your scrubs or trouser pocket and record the details of what you’re learning. 
• Ask what you can do: try to be useful. See if you can prepare anything; assist nurses etc.
• Think of great questions: and ask them to your supervisors. Your enthusiasm might rub off and open further doors.

Finally, as I’ve had to learn myself; don’t take things personally. Surgeons are busy doctors. Dealing with med students is sometimes the last thing they want to do.

Which is why I recommend learning the basics of surgery in your own time. Things like suturing etc that can be done easily at home with practice kits and the like. 

If you can show you have the basic skills to make their lives easier, more opportunities to learn will hopefully come your way.

For an international student like myself that also means knowing the local language well enough to communicate in the theatre too!

Studying Surgery: Resources

Knowing procedures in and out will help massively to your chances of exposure. To do that it’s worth exploring what resources you might use to aid your learning.

This vid breaks down a couple of good ones that medics swear by when it comes to surgery rotations…

Mentioned here is the excellent Surgical Recall. Having picked up a copy of this myself and already gone through over half of its contents (it’s a fast question-and-answer style read), I’m feeling a lot more confident.

It’s very similar to First Aid for USMLE in that it’s heavy on useful mnemonics, acronyms and tips etc – as well as distilling the whole subject down to its most important core topics (a true 80/20 blitz). 

Summary

Doing surgery in med school isn’t anything like you might see on TV. They take it very easy on us for the most part – perhaps a little too easy.

But then you probably wouldn’t want a coronary artery bypass graft to be done by us either I’m guessing!

Image Credit – @arturtamasjan at Unsplash