by Rami Sherif, MD, and Geoffrey E. Hespe, MD
University of Michigan, Department of Surgery, Division of Plastic Surgery
The path to becoming a Plastic Surgery resident is a long and arduous one. Current residents have done exceptionally well on their board exams, published numerous research manuscripts, and likely completed several away rotations. In order to navigate how to be an effective medical student, select a specialty, and then most importantly successfully match into that specialty, most individuals rely on mentors. Many times these mentors are residents who have already been through this process. It seems that when you graduate medical school that relationship changes in the blink of an eye, and you go from being a mentee to a mentor.
Becoming a resident is an equally exciting and terrifying time. You go from being a relaxed fourth year medical student to a doctor with real responsibility for patients. Intern year comes with a whole host of new challenges: admitting patients, prescribing medications, answering pages, printing the list, and simply learning basic doctoring can be stressful. This is all not to mention learning the basic principles of Plastic Surgery and prepping for cases. Moral of the story: it’s extremely busy once you start residency.
One aspect that can be particularly intimidating for new residents is teaching: specifically, teaching medical students at your institution. As surgical residents in academic centers, we obviously value teaching, and most of us desire to become successful teachers ourselves in the future. Unfortunately, at times interns and junior residents can hardly fathom doing so when we ourselves are at the bottom of a very tall mountain. None of this, however, should discourage any resident from teaching.
First of all, recognize that by virtue of completing medical school, matching into Plastic Surgery, and starting training, you already (hopefully) know more than a student on your service. Secondly, teaching is not ignoring your own educational needs; the best learning can be accomplished by teaching. Third, from our experience, medical students are eager to learn almost anything no matter how trivial you may think something may be. We have come up with some pointers to help you transition from student to teacher:
1. How to Be a Good Medical Student
Mentoring students on how to be helpful team members will not only benefit them but yourself as well. The expectations and workflow of surgery can be very different from other clerskship rotations that they may have been on previously. For example, teaching them how to be prepared for morning rounds and what supplies will be needed for dressing changes will make rounds more efficient. Help them help you and everyone wins.
2. Core Principles of Plastic Surgery
As previously mentioned, some of the best ways to learn things for oneself is to be able to teach someone else about a topic. Choosing a core plastic surgery principle is typically a great place to start. Topics like wound healing, skin grafting, the reconstructive ladder, and pathophysiology of flap reconstruction will introduce medical students to the principles of plastic surgery while simultaneously solidifying your own core foundations.
3. Basic Floor Management Principles
What do you do when a patient spikes a fever and how your differential changes depending on post-operative day? How do you manage low urine output? How about an acute drop in hemoglobin? Walking students through the thought process of how to manage these things are all essential to the 3rd and 4th year medical student who will be entering residency in the near future. Additional pearls that can be taught include how to manage and remove Jackson Pratt drains and how to perform flap checks.
As we all know, anatomy is the king of surgery. It will certainly never hurt to go over anatomy with students. Additionally, this is probably the most important aspect of a case for medical students. This helps them prepare for cases, answer pimp questions, and understand the surgeries. It also benefits you as it is a good way to force yourself to review this information.
5. Operative Skills
The operating room can be an intimidating arena for any individual not used to it. But for surgeons it is our sanctuary, and because of this we should try to make our students comfortable there. It is important to teach them the “rules” of the OR and introduce them to all the ancillary staff. While they are still getting acquainted, we should keep a close eye on them to make sure they don’t make any egregious mistakes like breaking sterility or contaminating the instrument table. Teach them how to be helpful with getting the patient prepped for surgery (putting on SCDs, getting the bed out of the room, placing foleys, etc). There are lots of way to get medical students involved, and they will appreciate it. Once they have gotten down the basics of the operating room, you can start to engage them in the surgery with tasks like retraction, operating the suction, and suturing.
There are few things that we as junior residents need to practice more than suturing. By passing techniques we learn on to medical students, we teach them valuable skills while honing our own basic abilities. Also, as Plastic Surgery residents, we are uniquely positioned to teach rigorous and fool-proof suturing methods. Teaching students the proper way to handle tissue, use instruments, and close wounds is important.
7. Enthusiasm About Plastic Surgery
Finally, we think that the most important part of teaching medical students is showing them how awesome plastic surgery is. We all know that it is the best specialty in medicine but it is important to show the students why. As an intern/junior your day can be overwhelming at times, but taking the time to do at least one of the aforementioned things will help your medical student have a great time on their Plastic Surgery rotation.
As Plastic Surgery trainees, we are incredibly fortunate to be part of an exciting and innovative specialty. For many of us, having great teachers and mentors in Plastic Surgery pushed us to choose this field and laid the foundations for our careers. Now it is our time to pay it forward, to share our passion and excitement with the students we work with. If we’re lucky, we can influence generations of talented and enthusiastic students to fall in love with our field, just like we did when we were in their shoes.