There are about 3000 young minds entering surgery residency in India this year. Most of them have waited for months and years to be a surgeon. During their internship as they assisted their PGs in a hernia and while suturing broken foreheads - all they wanted to be was “a surgeon”. It indeed is a proud moment for them and their families, I want to start by congratulating them for their phenomenal achievement.
However the path ahead is fraught with challenges and struggles. Surgery residency in India is one of the toughest and most brutal periods of a medical student's life. Some residents have a good life where they are treated with dignity. Others are treated as lowly slaves and drivers. You might learn a lot under a fantastic teacher or you might not be allowed to operate even a hernia all your residency. In the short term, these are extremely important. However in the longer run, these factors does not matter at all. One of the first things you must remember is that training doesn’t not end with residency. There is an option of doing senior residency is top institutes after your surgery residency where you will get exposed to best practices in the field. So never despair. One of the finest GI surgeons I know was allowed to operate on only 2 appendectomies throughout his residency. This did not stop him from being a maestro in GI surgery. One of the finest laparoscopic hernioplasties I have ever seen was performed by a surgeon who did his DNB in a corporate hospital well known in surgical circles for not allowing residents to even scrub up for cases. However both these surgeons had one thing in common: an intense desire to succeed.
How to be a good resident?
One of the most important qualities you need is compassion. Good residents are usually the most compassionate people you can ever meet. They work hard because they know that the effort they put translates into quality care for their patients.
A good resident also is a knowledgable resident. When you work in a high volume centre, you will be expected to take decisions that impact your patient’s care. Good decisions can be made only if the resident is reasonably knowledgable.
Residency involves a lot of effort and stamina. Investing in your health is extremely important. There are hardworking residents who tend to fall sick often. They miss out on learning and operating chance simply because their health doesn’t permit them.
Diplomacy is one of the most important aspects of residency. Indian surgery training is brutally hierarchical and negotiating through the complex maze of surgical heirarchy is not a simple task.
We shall analyse each parameter in detail.
COMPASSIONATE RESIDENT
It is a very tough task to be polite when there are 300 patients waiting in the OPD, especially when you haven’t slept for the past 36 hours. The surgical training programs in high volume centres are designed to be efficient, not patient friendly. However it is essential that you maintain your goodness and compassion even during residency. There will always be that one resident who doesn’t shout at patients and juniors. Invariably he/she is the one who evinces maximum respect from staff and doctors. That resident should be your example.
There are good selfish reasons to be compassionate. A small smile at the boy who pushes the stretcher goes a long way. When I was a resident at Madras Medical College not long ago, I would ensure that the OT boys had food before dinner time ends. I would also make sure that I learnt the names of every staff and worker who worked with me. Addressing everyone by their names shows that you respect them and have made the effort to learn their names. These small gestures go a long way. The OT boys would make sure that my case was wheeled in even before the brutes from orthopaedics rushed in to occupy the lone table in the emergency OT. On a particular summer post admission day morning when I almost collapsed due to dehydration, one of the senior staff nurses fed me with her own hands. These are moments which shall remain etched in my memory for long.
Compassion towards your patients is a must even before you enter residnecy. If you feel, you dont give a damn about your patients - surgery is not the place to be. Treat your patients as human beings, not as operating opportunities. If you feel that a T4 lesion in the breast needs chemotherapy before surgery, dont push for surgery just because it is your chance. If a patient with rectal CA needs neoadjuvant RT before surgery, it is important that you ensure that the right treatment is ensured.
Be an advocate for your patients. Fight alongside them for their rights. Most of the patients in government hospitals have come here because they have nowhere else to go. It is matter of huge privilege that you are given the opportunity to treat them. For you it might be just an emergency splenectomy. For the mother, it is her 24 year old son who has had a major accident and is battling for his life with a shattered spleen. A patient is not just a case. When a patient or an attender has a query, take time to explain to them the situation. If you dont have the time, apologise and promise them that your intern will answer the query or you will come back later. Do remember to keep your promise. It is quite easy for me to type these things but your small gesture will be remembered for a long time.
At the end of the day, be the resident you want to be treated by.
In the next part, I will discuss on strategies to study during residency.
Recommended reading material about surgery residency
- Heart, Guts & Steel: The Making of an Indian Surgeon - Dr Sivasubramanian
- Complications: A Surgeon's Notes on an Imperfect Science - Dr Atul Gawande
These 2 books about a surgery resident’s life also talk about the human aspects of residency. A lot of young Indian residents will able to relate to Heart,Guts & Steel which is about residency in a Bombay Hospital by the ever brilliant Dr Sivasubramanian.
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.
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