Surgery!

This new year is shaping up to be pretty exciting, and part of the changes in my life will be reflected in what I write about on the blog. First let me explain how the MD/PhD program I'm in works, and where I am in it.

The Medical Science Training Program (MSTP) or MD/PhD program is designed to promote bench-to-bedside or translational research. The idea is that if you take medical students and give them a PhD as part of their education they will be more likely to take science from the basic literature (bench research) and translate it to medical care (bedside research) or at least do research that is more applicable to clinical research. In practice this ideal is not always achieved, but we try. This program is funded by a grant from the NIH, and between 2-10 such positions exist at most medical schools.

The program starts with students doing two years of medical school, which at most U.S. universities consists of the basic science portion of the medical curriculum. In the first two years you learn biochemistry, physiology, anatomy, histology, pathology, microbiology, pharmacology, genetics, psychiatry, etc. and at the same time are introduced into clinical medicine, differential diagnosis, taking patient histories, physical exam, and all the other skills you need to become a medical doctor.

After you complete these two years, and take the first of the national standardized tests to check and make sure you're not a total incompetent, MSTP students then go into graduate school. Yes, some intelligent people actually think this is a good idea and enter this program. Luckily, you get a good deal of credit to your graduate classes (or substitute some graduate classes in medical school) and for the most part go straight into lab work. Then it's the standard grad school spiel which I explained previously. Briefly, you work in a lab, you struggle, eventually figure out what the hell you're doing, and then write a thesis. Now the fun part, after being separated from the first two years of medical school by between 3 and 13 years you get tossed into patient care for the medical school third year.

The third and fourth years, referred to as "the wards", is more like a medical apprenticeship. You spend between 4 and 8 weeks on a variety of wards learning the full breadth of medical practice. These consist of family practice, surgery, psychiatry, medicine (ICU, infectious disease, slumming around the hospital etc.), neurology, pediatrics and OB/GYN, and whatever electives you decide you are interested in. This is when you really learn medicine and how to apply your clinical knowledge to the actual treatment of sick human beings.

I've spent the last month studying, working with doctors to get my clinical skills back, and generally freaking out in preparation for tomorrow, my first day on the wards. And guess which I'm doing first!

I start on surgery (if you couldn't figure this out from the title you forgot your morning coffee) based on the masochistic idea that I'd like to get the clinical rotation I think will be the most challenging out of the way early. No slipping into the pool slowly for me, I'm diving in head first.

Surgery is tough, you start at about 4 or 5 am on the wards pre-rounding on patients - waking up tired, surly, sick people and asking them if they've farted lately, I kid you not - and getting ready to report to your resident around 6am. At 7am you spend an hour in a little lecture (being surgery a very Socratic one - aka pimping) before going back to work for another 8 hours. After multiple 14-16 hour days you get to be on call, which gives you the potential for some seriously long hours.

Medical students get to watch some actual surgery be performed and may even get so lucky as to hold a retractor or cut a suture. Mostly you stand on the periphery, get asked lots of difficult questions, and try not to faint from the smell of the cauterizer. I hear it's a real blast.

So, that's what I start doing tomorrow. What this means for the blog is that I will take a more medical focus in the coming weeks, and things will likely be a bit slower for the next 12 weeks that I'm punishing myself with surgery rotations and surgery electives. I have no doubt it will be interesting, and I will try to relate what this experience is like, and how medicine intersects with science as I learn it. When I have free time and am not frantically studying to avoid the inevitable embarrassment of knowing nothing about what the hell I'm doing, I promise I'll write about my regular ass kickings. I won't be able to write too much about any individual cases as a non-anonymous blogger, but in the future, with details changed and a non-contemporaneous time line, I'll share the kinds of things I find interesting about the practice of medicine in America.