A month into surgery – back to the books

I’ve just completed my first month of my surgical rotation and still find almost every day fascinating. I just finished a 4-week rotation in the hepatobiliary service (liver, biliary and pancreatic surgeries mostly) and now go on to thoracic for 2 weeks, and then trauma for 2 weeks to complete the core requirement. I’ll also be doing orthopedic trauma and neurosurgical rotations before I’m done in March and I’ll be sure to write about those as well.

Friday night we had the medical student pimp-off AKA surgical jeopardy. For the uninitiated, pimping refers to the practice of quizzing students on the wards to make sure they’ve been studying (or occasionally to show off one’s own knowledge of medical minutia). For surgical Jeopardy/the pimpoff the residents get all the medstudents on the general service rotations together and quiz them Jeopardy-style. It was a lot of fun, one team even had t-shirts made, everybody was getting pretty into it. I even won a book! Although I’m afraid the smack talk may have gotten out of hand. Oh well.


And speaking of books, I’ve just got to write about what it’s like constantly having your nose in one. Above is the ICU Book I won Friday, as well as the Essentials of General Surgery textbook which is more or less required reading for the rotation. Then there is Surgical Recall (my cat is investigating), a book born right here at UVA which consists of several thousands of questions and their answers. It’s kind of a survival guide for the rotation since the questions are the kinds of things you’re likely to be pimped on. Like, what is the gastrinoma triangle?

Books for me have almost become a form of self-medication. When you start medical school, often fresh out of college, you quickly are overwhelmed by the sheer volume of information you must assimilate. These are the basic science years and in a way the first year is the most difficult. It’s a little bit like trying to drink water out of a fire hydrant. The material isn’t even necessarily challenging, but the sheer overload of information becomes overwhelming.

Somewhere in the middle of second year though you wake up and realize you’ve adapted to the information flow and suddenly you can rapidly absorb absolutely huge amounts of knowledge. You’re all proud of yourself. It’s great, and studying doesn’t seem to be as much of a chore.

Now I’m in third year and it’s back to drinking out of the hydrant again. Not only is the sheer amount of material for any given rotation overwhelming, but in addition you’re learning to apply it practically – a very different beast – while trying learn about managing real patients. I think it’s something people seldom appreciate about medicine is just how immense it is, and every field within it you could devote an entire life of study to. For example, wandering around the library looking for the textbooks to prepare for my next rotation I found these two hefty fellas:
These are huge volumes, with very dense material. Each subspecialty is daunting. Say you want to study plastic surgery?
Or, God-forbid, opthalmology?

See what I mean? You really get the feelings as you go along the best you can do is dent the surface, and you really appreciate why specialization has become so extensive. Each of these multivolume books contains hundreds of chapters dealing with specific diseases and descriptions of medical therapy or surgical techniques. Each chapter represents the work of an expert in that field who essentially writes a review of the scientific literature and current practice applied to a single problem or family of disorders. And on top of that, since texts are constantly going out of date, they are just the starting point. You must always keep up with the current literature on any given problem as you are treating your patients.

The amount of information you don’t know becomes overwhelming. Although these days studying is oddly no longer a chore, but one of the few ways I can decrease my anxiety. You see day to day how critical thorough knowledge of medicine is. And when I get nervous about how little I know I compulsively go out buy a book. It’s an expensive habit, but it seems to be the only thing that decreases the stress of having such inadequate knowledge. Hence I’ve become the Amy Winehouse of textbook purchasing.

Then there is the most frightening thing of all – the realization that the feeling you don’t know enough will probably never go away.


  1. Have u try the online bookstore Cocomartini

    I get all my textbooks for this semester from this bookstore. All are brand new textbooks and half price discount textbooks.

    Good luck and wish some help.

    hehe ^_^

  2. Wow, you’re tuned in enough to write a blog, but still using textbooks? Do yourself (and your poor, overworked wallet!) a favor and invest in an MDConsult or UTD subscription (and I suspect UVA’s library has remote access for free). Your textbook is already out of date. You can’t trust anything in it. That’s the nature of the fire hydrant–it’s new information and it doesn’t turn off when you finish your surgery rotation. You just aren’t there to drink from it anymore. So find a more accessible source, and preferably one that updates more frequently than MDConsult.

    As an internist, I have exactly 1 textbook: Harrison’s. And it was a gift. I use ACP Medicine (online and updated continually), UpToDate, and good-old Pubmed.

    The trick of medicine is not getting access to the information: the internet has made this simple. The trick is to filter things. Medical knowledge expands at a rate of 7% per year. There are millions (seriously) of articles published each year. Perhaps the most important skill of a physician is filtering those millions of articles to the roughly 1000 he/she might read each year.

    Bottom line, things like Surg Recall are great to get you through your rotation. But look at textbooks as a highly perishable resource–if you buy any, limit it to “the” textbook for whatever residency you are going into.

  3. Have you read Ferguson’s Reconstructive Surgery of the Esophagus? It’s riveting.:)

  4. Christine

    Love the blog! I’m also a 3rd year medical student and I’m also in the first month of my Surgery rotation. I hear what you’re saying about how studying decreases stress level. CaseFiles has become my new best friend, although I’ve been carrying Surgical Recall around all month, too. And Essentials is surprisingly readable.
    I’ve done a month of General Surgery at a VA hospital; I do two weeks of Breast Surgery and then two weeks of Ortho next.

  5. Those are great books you’ve got there. And those pictures look like my hospital’s library. I know exactly what you mean about buying books as stress relief. When I felt really overwhelmed this year, I went and bought the ICU Book, and a Step 3 guide. If I’d had more money, I would have bought Mastery of Surgery, which is two huge volumes.

    And if there’s a time when one starts to feel less ignorant, I haven’ encountered it yet.

  6. George G

    Great post. So true. I’m and MSI and I’m glad to hear that at some point you might just be able to learn quickly. It seems that I’m always about three steps behind, and I do everything I can to keep up.

  7. I’m always looking for more books to add to that library in my head. Surgical Recall looks excellent. Mastery of Surgery sounds intriging. I’m surprised that Essentials of General Surgery is a required read. Internet resources are great, up to date and yes, cheaper, but somehow not as cozy nor as convenient as a textbook.

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