“I Thought I Matched into Plastics!” – A Guide to General Surgery Internship

by David Chi, MD, PhD1, and Rami Sherif, MD2

1WashU Plastic Surgery

2Michigan Plastic Surgery

Congratulations to the new wave of plastic surgery residents! …now welcome to general surgery. 

All plastic surgery interns and most junior residents will spend a significant amount of time on a variety of general surgery services. Rotating on these services can be challenging for a number of reasons, foremost of which is feeling like a fish out of water. As a separate specialty being lumped in with the pool of general surgery interns, you may often feel overlooked, but the key is to embrace being different. The difficult journey to matching in plastic surgery has prepared you exceptionally well to be the strongest interns, and you will often find the general surgery chief residents and attendings are happy to have you rotate on their services. While plastic surgery residents at your institution will have pertinent advice, here are some universal lessons learned from former plastic surgery interns at programs around the country.

It pays to excel at your job… whatever it is.

Intern year in general can be difficult, and mundane duties like managing the general surgery floor can seem like you’re just being used to fill the general surgery call schedule. The truth is, you probably are. But a word to the wise, EVERYONE TALKS. From the nurses, NPs, PAs, residents, fellows, attendings, to the chair, respect is earned, and if you gain a good reputation, you may find yourself presented with your choice of cases, increased operative experience, or even being sent home early to rest sometimes. No matter how far your intern tasks can seem from plastic surgery, the thread of surgery runs through it all, and try not to lose sight of that even when you are 10 Whipples deep into the year. You’ve excelled to get to this point, and now is not the time to stop. 

People skills.

Much of surgery is talking and listening to others. As an intern and surgeon, you will be spending a lot of time talking to nurses, mid-level providers, and other residents via the multiple phones/pagers you are carrying. Learn to respond to all the phone calls with as much kindness and (appropriate) humor as you can muster. Be humble, know your limits, and always call or text your senior with questions. It’s always better to over-communicate than to go rogue and be THAT intern who starts random heparin drips or uncalled for orders on their own overnight. Annoying your senior or getting called out for waking them up is far better than making a mistake leading to increased morbidity or complications for your patients. Your reputation is worth its weight in gold. A year later when you’re the plastic surgery consult resident seeing intra-operative consults from your general surgery colleagues, having these good relationships will pay off for you and your patients.

Enjoy the freedom.

One of our plastic surgery chief residents once said, “You are CEO of your own education.” During your general surgery months, you will work hard, but as an off-service intern, you may not be officially evaluated by your general surgery superiors. Enjoy the freedom from being self-consciously under constant scrutiny! This does NOT mean to slack off, but it does mean that you can focus entirely on patient care without any distractions. Do not forget that your primary goal as an intern is to provide excellent care for your patient. Beyond that, you should use this freedom for your personal enrichment, whether it be exercise, sleeping, research, or plastic surgery. After ensuring the best care for your patients, do what is best for yourself and your chosen profession in plastic surgery. No one will care more than you.

Learn to care for critically ill patients.

While we frequently consult and operate on very sick people, we are usually not the doctors primarily responsible for these critical ill patients. These general surgery months are thus incredibly useful in training you to care for sick patients. Since many of our cases are referred from other surgical services, the time we spend rotating on these services is crucial to understanding their perspectives and surgical priorities and will help greatly in seeing plastic surgery consults later on. Throughout various core rotations, you will learn ventilator management, using anticoagulants, caring for coding patients, and everything in between. While it may be easy to think that so many of these lessons and experiences will never apply in plastic surgery, surgeons must prepare for all contingencies. Don’t forget that the single most important goal of an intern is to learn how to be a doctor.

Teach medical students.

You will encounter the majority of medical students during your general surgery rotations as they go through their third-year rotations. In contrast, once you are on plastic surgery, you will mostly cross paths with plastic surgery sub-interns or third years already considering plastic surgery. Remember how you felt as a student on surgery rotations, then multiply that by 10 given that the majority of medical students you meet will not enter surgery. You are well-placed   to help them acclimatize to this alien new world of surgery. Simple tips like where to stand, how to prep the patient, and how to suture will mean the world to them. The fact that you generally will not be asked to evaluate them as an off-service resident will make your interactions with them less intimidating and allow for genuine education. The best learning for yourself can also be accomplished by teaching, and essential concepts of plastic surgery like surgical anatomy, wound healing, perfusion, trauma assessment, and the reconstructive ladder have a place in core medical education. In doing so, you may also open their eyes to the innovative field of plastic and reconstructive surgery.

Plastic and reconstructive surgeons have long been described as “the surgeon’s surgeon.” To maintain that worthy moniker, it is essential that we absorb as much knowledge and experience from every surgical field, and that begins with intern year. 

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