World Surgery Forum: DM/MCh

I have always enjoyed interacting with surgical residents and one of the first questions the young resident who enters surgery asks me is “ How do I study during residency?” Studying during a tough surgery residency is not easy at all. The biggest hurdle will be your seniors and colleagues who will discourage you from picking your books. The long hours, lack of sleep and abusive seniors just compound things. But one fact we forget is - studying in residency is not a privilege, it's a duty. Acquiring knowledge so that you can treat your patients appropriately is a fundamental duty.

This article will be a continuation to Part I of being an amazing surgical resident.

HOW TO STUDY DURING PG LIFE?

IN THE WARD:

The best surgical atlas an Indian resident can have is the patient himself. The good caseload in most Indian centres means that there is no dearth of surgical material. The optimal way to start studying is to read about the cases in the ward everyday. The moment a case is admitted in the ward, pick up your Washington Manual of Surgery and start reading about it. The Washington Manual can be used as an e-book on your phone or tab. The Washington Manual of surgery is a small and concise handbook that doesn’t delve too much into theoretical aspects of surgery but merely lists out the concepts, diagnosis and management of a particular problem. Residents who can afford to shell out significant chunks of money can also spend on UptoDate. UpToDate is one of the best resources a resident can subscribe to.

Keep in touch with recent research. Just type in the keywords on NCBI/Pubmed website and checkout the most appropriate research paper. Even if time doesn’t permit you the read the entire paper, read the abstract and try to understand it.

IN THE OPERATING THEATRE:

The operating theatre can be quite intimidating as a first year resident. One of the best ways to come out unscathed out of the OR is to read well before surgery. Use Farquharson's Textbook of Operative General Surgery to read upon on the operating steps. If you have time to read the previous night, use Fischer's Mastery of Surgery 7th edition. Fischer’s is a fantastic resource which explains the anatomy and the surgery in detail. For a first year resident, it might seem like a humongous task to go through it. But the effort you put into understanding the concepts in Fischer’s will reflect on your operating table.

For understanding the basic principles of surgery use Kirk’s Basic Surgical Techniques 6th edition . This book will teach you the methods of knot tying, suturing, fixing a drain and inserting a chest tube.

However the best resource for operative surgery is YOUTUBE. The absolute wealth if content YouTube offers you is unsurpassed and the only hurdle will be in dis time ting between good quality content and useless videos.

The NCCN guidelines are the most important resource a resident can use before treating a patient with a malignant condition

YOUTUBE CHANNELS TO FOLLOW:

https://www.youtube.com/channel/UCVpqNpkdJtxqSDw8C2Lw4XA - The official channel for Learning General Surgery. The ultimate resource on surgical knowledge especially after the lockdown lecture series. LGS videos are extremely well curated

by Dr GD Sharma and Dr Patta Radhakrishna.

https://www.youtube.com/c/SurgicalEducator - Basics of surgery - essential for every resident

https://www.youtube.com/c/Surgery101 - Surgery basics explained in simple terms

https://www.youtube.com/c/SAGESVideo - SAGES channel. Follow for high quality laparoscopy training

https://www.youtube.com/channel/UCTOg68oXp2S-yIPz0tkTewA - Operative surgical oncology by Dr Marimuthu of Thanjavur, Tamil Nadu

https://www.youtube.com/user/surgyserg - Follow the Ukrainian maestro Dr Baydo for daredevil laparoscopy

https://www.youtube.com/channel/UCVpqNpkdJtxqSDw8C2Lw4XA - Dr Omedary teaches us how to tie surgical knots

https://www.youtube.com/channel/UCE1sLGb-8COMdl0_xkdxD3w - Dr Ashwin’s laproscopic Hernia videos are a must watch

I can keep talking about wonderful surgeons on YouTube. Really soon we will do a separate exhaustive post on YouTube channels for surgery residents.

BOOKS YOU SHOULD BUY

Bailey and Love Short Practice of Surgery, 27th edition - Read basic aspects of surgery and urology from bailey. You need nothing more for final exams and also NEET SS

Sabiston Textbook of Surgery, 20th edition - GI Surgery is best read from Sabiston,. It is quite exhaustive and an absolute deligh to read. Residents interested in GI surgery should never complete residency without reading Sabiston.

Schwartz Principles of Surgery, 11th edition - Breast and Thyroid chapters are extremely detailed and thorough in this masterpiece. A definite must-read.

Clinical Surgery Pearls 3rd edition by Dr Dayananda Babu This book is the living soul of every resident preparing for final year exams. For clinical surgery, this is no-brainer. You should definitely purchase the hard copy.

Bedside Clinics in Surgery 3rd edition by Dr Makhan Lal Saha - This beauty of a book is a lifesaver in final year examinations. Certain chapters like abdomen examination are never omitted.

A Manual On Clinical Surgery by S.Das 14th edition. This book is now in its 14th edition but shall never go out of favour. You would be committing a sin if you don't read ulcer and swellings from this evergreen book. Note: Even if you possess an older edition, it doesn’t matter - Nothing ever changes in successive editions.

Separate posts will cover books that GI surgery, Onco surgery, Neurosurgery and Plastic aspirants should buy.

APPs

I used to read Bailey during my PG days and would always wish that I has an application on which I could solve MCQs so that I could simultaneously prepare for NEET SS. There were a couple of web based options but none were good for daily use in the ward. I ended up developing the SURGTEST app with a group of friends so that residents could use a handy app that would work even at low internet speeds in dimly lit, dungeon-like wards with a whole host of network issues. The general surgery question bank with more than a thousand questions based on Bailey and Love 27th edition are exhaustive and a must-have for every first year surgery resident. The questions are arranged topic wise and will help you revise core topics at ease. The Onco surgery question bank based on MD Anderson Surgical Oncology Handbook 6th edition and NCCN guidelines should be on the wish list of every resident aspiring to be an hot shot onco-surgeon. The GI surgery package is about to be released soon. There are also extensive video lectures on GI surgery which would be an invaluable resource on GI surgery for residents. Residents can contact the team for discounts.

I have covered a few aspects of studying during residency. In future chapters, I will cover research during residency, negotiations seniors and diplomacy while a resident and a few other topics. Since it is an extensive topic, I have not covered MRCS preparation. MRCS preparation is definitely possible even while you are a resident and I am gonna tell you how to crack both parts of MRCS even before you finish MS/DNB.

There is nothing more satisfying than treating the patient the right way. The patient puts his/her full trust on you. It is extremely essential that we understand this. It is a huge privilege to be a surgeon. That privilege comes with a huge responsibility. One major aspect of that responsibility is acquiring knowledge.

Learn well. Treat well.

Vinayak Rengan is a General surgeon from Chennai who completed his Surgical residency at Madras Medical College. He is a compulsive news junkie who regularly writes for print media and runs a blog The Stonebench where he writes on technology, public health and politics . He is the co-founder of Surgtest - a surgical education platform which helps surgeons prepare for NEET SS and MRCS.

#neetss #surgery #residency #indiaPG #Generalsurgery

Read Similar Posts

HOW TO BE AN AMAZING FIRST YEAR PG IN SURGERY? - PART I (THE COMPASSIONATE RESIDENT)

https://www.worldsurgeryforum.net/2020/06/how-to-be-an-amazing-1st-year-pg-in.html

7/03/2020 01:47:00 AM

Indian Medical and Surgical Superspecialty seats

By this recent trend of superspeciality seats going empty shows that there is something going really wrong with the medical higher education policy.

Amongst the surgical branches, the ones which are majorly impacted are CTVS surgery on the top, followed by paediatric surgery and plastic surgery.

Amongst the medical branches, cardiology on the top, followed by critical care, nephrology and gastroenterology. Below is my analysis of possible causes of this trend:

Widespread prevalence of unreasonable service bonds by the state governments for candidates joining super specialty seats:

To join a super specialty seat there is already requires so much sacrifice which is made by the candidates on economic, family and personal front but by bringing the draconian service bonds into picture it becomes all the more difficult and counterproductive to join a superspecialty.

Government colleges in different states ask students to sign bonds to serve in their hospitals for a minimum of three years and a maximum of 10 years after finishing the course. For instance, Tamil Nadu wants a candidate to work in the state for 10 years; only then a candidate can practice on his own freely. Already the average age at which a candidate joins is 32-35 years, by the time a candidate finishes his bond service, he would be approaching the age of retirement or would in a grip of some lifestyle disease having wasted all the happy years of his/ her youth.

Inhuman working conditions and impossible number of work hours with all the responsibility

With no regulations on work time for resident doctors in place, in most states the residents have to do duties ranging from 24 to 48 hours at a stretch and monthly number of working hours ranging from 400-500 hours, which is highest amongst any of the developed or developing countries in the world. Owing to lack of specialist doctors, superspecialty residents have to virtually bear all the workload in these specialty institutes or departments with all the responsibilities. Family responsibility and personal mental and physical well being tends to be totally neglected for the whole 3 years.

The specialties affected more are the ones which are more physically demanding or are perceived to be with low scope

Specialties like CTVS and Pediatric Surgery are perceived to be more physically demanding. CTVS is mostly concentrated in big cities because of a costly setup (requirement of heart lung machine, ECMO machine etc), hence also contributing to lesser new job opportunities compared to other branches.

Whereas with Paediatric surgery the issue is different, it is in a gray zone where in a lot of patients can go to a General surgeon or a super specialist as per the system involved. Corporate hospitals also do not support Paediatric Surgery as it is not so lucrative for them. Most of the Government Medical Colleges also do not have a Paediatric Surgery departments. Hence greatly limiting the opportunities for a freshly passed out graduate. However, gradually the demand of Paediatric Surgeons is definitely on a rise in Tier 1 and Tier 2 cities.

Similarly for plastic surgeons there are not many positions in corporate hospitals compared to Urology, Surgical oncology, Gastrointestinal surgery or Neurosurgery. One reason for this is a lower case loads and the practice is mainly dependent on referrals from general surgeons, oncosurgeons, orthopedic surgeons and pediatric surgeons. You have to work under the shadow of a senior surgeon for few years in corporate hospitals before you can kick start your own practice.

Comments

Jithu George Kanipayoor Now a days government is increasing PGSS seats indescrimately.Here in our state ,there is about 20 pediatric surgery seats (Mch).Suppose if 20 surgeons are passing put each year with Mch ,is there any proportional vacancy in either government or private sector ?Are the number of job opportunities increasing each year ?Hence most of the seats are left vacant, a kind of natural correction .

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- Manjunath Subramanyam Jithu George Kanipayoor agreed , but across the country definitely scope is there , the councils / MOH has to provide the infrastructure which is lacking .Fir example in KIDWAI there is no definitive PRS department , it’s a premier cancer institute , today it’s the era of sub specialty group practise but where do we stand , I hope it’s the same scenario in many centers . How can we expect things to change !
  
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Puneet Sharma Correct

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Murali Guntoju Number of pg or ss seats have increased as per population demand, but employment has not increased at the same ratio. People are afraid to take few branches as the salaries paid in these branches has decreased and also the no of specialists increased.

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Raja Shanmugakrishnan The quality of many institutions are also not great in many centres

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Manjunath Subramanyam The scope is huge and tremendous , but right administration is what matters I believe , ex Kidwai doesn’t have definitive PRS department , today it’s the era of sub specialty practise , it can be turned into another CHANG GUNG , but who and how , it …See More

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Anirban Kundu Well said Sandeep, but of late we’re also noticing a trend where 6 years DNB super specialty seats are being filled up, at least in CTVS. Perhaps this is owing to the relative uncertainty regarding PG admissions in broad specialty courses, and the candidate plumps for a super specialty course so as to stave off any future uncertainty.

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Skanda Shyamsundar There's only one main reason for this. The name's Bond. Education Bond!

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Skanda Shyamsundar Too many seats, too easy to get!

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