Trauma Rotation and Introspection about What I Would Like in a Residency Program.
I have been in my trauma rotation for two weeks and have had a very awesome experience. I have this week left before I go to the bariatrics portion of my surgery core, which will wrap up my third year of med school over the next four weeks. I have enjoyed the surgery rotation, and it has really imparted on me the desire to perform surgery as a function of what I do. I still really enjoy the scope of Ob-Gyn and intend to apply to residencies that will prepare me for a physician and surgeon dedicated to women's health. I wanted to write this piece today to reveal my experience so far in trauma, and to relate what it has taught me about what is important to me in a residency program.
TRAUMA: Life in the ED
The ED (Emergency Department) is a specialized place within the hospital where healthcare teams from surgeons, ED docs, and other specialties intersect to welcome patients into the hospital (or discharge them for outpatient care), and determine the initial course of treatment for a patient. The trauma portion of my rotation is with the team of trauma surgeons and residents dedicated to seeing the Level I and II traumas that enter the hospital, along with surgical consults needed for the hospital.
When the trauma bell goes off, the intercom will announce the trauma level and the amount of time before the team needs to assemble in the trauma bay. So, when "Level I trauma, ETA 10 minutes" is announced over the intercom, the members of the trauma team assemble in the trauma bay with personal protective equipment and a readiness to start the orchestrated events necessary to stabilize a patient and begin resuscitation efforts. Not every trauma that enters means the patient is at risk of immediate death, but it is essential to be ready to act at a moments notice. As a medical student on the team, it is my responsibility (or one of the med students on the team) to be actively documenting the history and physical exam results obtained during the initial assessment. A trauma surgical resident typically receives the patient at the trauma bay and begins assessing the ABC's (airway, breathing, circulation) of the patient and then the EMS personnel will begin describing the event that took place and the measures taken while the patient was en route (this is known as taking report). After report, the nurse assigned to the patient begins placing IV access, the resident begins a physical assessment of the patient along with a FAST exam (ultrasound looking for any signs of bleeding), the ED physician and surgery attending supervise the events and direct things that need to happen, and the medical student can directly ask the patient pertinent questions from the history (PMH, PSH, FH, SH, ROS... seem familiar??? It's what you should be preparing for STEP 2 CS...anyway). The process is fluid and once you are apart of a couple traumas, the repetitive process becomes second nature.
My experience in this rotation has taught me a lot about how residents work with each other and how they function within the hospital. Next, I will describe what I have gleaned from my experience and how that has shaped what I want out of a residency program (or at least how to start articulating that since I will be applying this fall for a residency placement).
Residency Traits for Me
Camaraderie - This is essential. I am not looking for a program that highlights teamwork in their introduction, but clearly palpable camaraderie between the residents. I think this is essential to working together since the residents can be a resource for each other when it comes to dealing with the responsibilities of the service. Each year, the trauma program hires 3 residents who learn to rely on each other for learning different things and covering each other when something goes awry. I want to work alongside residents who feel like their colleagues are capable of helping them, and distribute the burden of the workflow between everyone. I think a resident should not feel like they personally failed the patient, but that the team fell short of the patients needs because as a team we are in this together. This isn't to say that we all deserve to have an individual level of responsibility to the patient's care, but a team-driven approach helps distribute the burden of patient care evenly along with the mishaps that will happen. A collaborative effort, in my mind, should help with patient-centered care overall and improve outcomes on the whole. Therefore, I want to bring my team-centered approach into an environment where it will thrive.
Attendings who Inspire - By the nature of medicine, mentors are generally found in those who are of a higher rank than ourselves that can help nurture the qualities within ourselves to improve. My current attending is someone who has a reputation of being difficult to approach (along with other choice words I have heard from my peers...), but I have found that my attending is a surgeon who leads by example. My attending may be more difficult to approach for many, but she has the qualities to be desired in any surgeon. If I was to choose a surgeon, I want someone who possessed the same qualities as she. I admire these qualities like the ability to maintain a calm and collected demeanor when the stress levels in the OR are extremely high, or the ability to garner respect from quality patient care without sacrifice. My current attending is a busy person and generally the students learn from the residents, however that does not mean you won't see her on the front lines with the residents in the OR or by the bedside. I can see the respect residents have for her, and the relationship between my attending and the residents is similar to one that I would appreciate myself when I am a resident.
Autonomy - I think a level of autonomy that grows with each year of residency is important to the development. This is something I experienced some during my psychiatry rotation that I was reminded of during my trauma rotation. Autonomy for someone intrinsically motivated like myself is essential for fueling my desire to push myself to higher levels of understanding. When there is autonomy, I am more invested in patient outcomes (outside of the generic "I want to help people"), and I am more likely to read twice-or-three times as much to make sure I don't miss anything that could adversely affect the patient. That does not mean that I don't want some level of involvement on behalf of my superiors, but I think it is important to make the resident feel empowered that he or she has the skills necessary to perform well while providing an arena that makes seeking help an okay thing to do. Knowing the limits of our abilities is important, and I want to be apart of a team where I will be allowed the chance to express my abilities as long as I am able to show the proper use of the chain of command whenever limitations present themselves.
Structure - I think a well-planned curriculum that supplements what cases are seen in public is important. Not every program has a set schedule of what lectures will be taught when but I do appreciate when things are planned out and there is some semblance of predictability in what will happen. The surgery program at this hospital has an outline of what each intern or resident will be doing over the various months, and I think that is helpful when it comes to planning out other things that might be going on in you life. This is the one point in this list I will say is more optional than the others. I can be a flexible person to an extent as long as I have time to assimilate what I am being flexible about into my mental framework...I know that may seem a little rigid but in my mind it works! I think flexibility is essential in medicine, and I think what I am trying to convey is that I do not want to join a program that is haphazard or chaotic.
So as I end this month by finishing my last rotation of third year, I have already begun reflecting on how much third years has accelerated my growth and a healthcare professional. I look forward to the residency application process that starts this fall, and all the adventure I think medicine will continue bringing my way.
