Thursday, April 8, 2010

18. How to ace the surgical practical?

A team of 3 classmates from the 4th year will be assessed on their surgical skills. One will be the surgeon, one the anaesthetist and one the recorder for the forthcoming test. The students would have theoretical knowledge from lecture notes and a video of the surgery prior to the practical. For a student who wants to be in the top 2%, this test is very important as every mark counts.

The surgery. Anastomosis of the small intestines in a pig. None of the students had performed this surgery. I assume none have seen it done when they see practice as it is an uncommon surgery. It is not a simple surgery. Poor stitching will lead to leakage of the intestinal contents and septic peritonitis. The stress is extremely high if one wants to ace this first-time difficult surgery.

How to ace this practical test?.

1. Don't be the surgeon. Unfortunately, none of the 3 volunteered. A lucky draw picked out one girl to be the guinea pig. The other 2 can relax.

2. Get hands-on practice after knowing the theory and watching the video. This is what differentiates an "A" student from the rest of the pack. None of your classmates will bother. Why should they? They are not interested in being top 2%. This will be to your advantage as you will shine in the sea of mediocrity.

3. Know the competition. The 80:20 rule in life says that 80% of a cohort will not be interested in excellence. The 20% contributes to 80% of the production. So, in a team of 3, one may be interested in scoring the highest mark in surgery. The sample is too small for the 80:20 rule. I did a bit of research into the motivations of this group.

Surprisingly, the 80:20 rule does not apply to your group. I know there is another girl who wants to excel and is in the top 2%. I don't know about the 3rd person who may be influenced by the competitiveness of both of you. At least 2/3 wants to ace this practical. That exceeds the 20%.

4. Pass the buck to your competitor. "Let the other girl be the surgeon", I advised this girl. "She has had worked more in seeing practices and is older. "It is not fair," the prospective student-surgeon said. "But is life ever fair? My question is 'Will she rise to the challenge and accept this position?"

5. The competitive edge I doubt it. Why volunteer to be a pioneer to blaze the trail and suffer personal damage? "Is she agreeable to be the surgeon?" I asked again. "Not really." the girl replied. Well, this competitor is very smart. Very sharp. Yet she is magnanimous in giving this unlucky pioneer-surgeon some fishing line to practise surgery. She knows she has the advantage of seeing practice. I don't think she has had the practice of anastomosis. In any case, she is in an enviable position of not being required to perform the most stressful task of the group. Fate has had chosen you. Yet, Fate has given you a mentor if you have been able to read the stars accurately. That mentor is me.

6. Correct tools needed. Know your stuff. "Fishing lines are nylon. "No teacher is going to teach you to use nylon in the anastomosis of the jejunum," I asserted. I may be mistaken but I am quite sure that it is not the correct way to teach students in this particular type of surgery. Fishing lines are too thick if I am correct. Inserting a fishing line into a suture needle to stitch up the intestines should never be taught. This will lead to big holes in the intestine and seepage of intestinal fluids. The suture should continue from the end of the needle instead of being inserted as in a clothes sewing needle. So, you must understand and know the tools of the trade.

7. Where to get such tools? You just buy the absorbable suture packs from the practising veterinarian.

8. Where to get the pig intestines? "Don't they have the small butcher shops in Australia selling pig intestines?" I asked. I graduated from Glasgow University in 1974. There were small butcher shops selling such intestines. At that time, I never was given a similar task nor did I perform any practical surgery. It was almost 30 years ago and 4th year vet students didn't do practical surgery on live animals. There were no surgery videos nor the internet.

7. Practice, practice, practice. You just got to spare the time to stitch and stitch at least 100 anastomosed intestines if you want to be confident and get top grades. No easy way out.

8. Get a mentor A vet who had performed surgery for many years to monitor your surgical stitching. Not necessary pig intestines. Dog intestines will do if he or she is in small animal practice. Nothing beats having somebody to show you how it is done and then supervising you doing the anastomosis.

7. Seize the moment. I was available for the last 5 days and had advised that you buy the pig intestines and get on with the surgery practice. Today will be my second last day in Australia.

8. Be Proactive Overcome your inertia. Just go out to buy the intestines and practise, practise, practise on a hundred jejunums yourself. Devote time to it. On the day of the trial, you will just do it with two eyes closed and get 100% score. In countries like Taiwan and India, I hear that vet undergraduates have lots of surgical experiences, but in the Western education model, animal welfare prohibits such undertakings.

But there are other alternatives like the butcher shop. It is as easy as that, but the vast majority of the 4th year vet students will never do it. They have better things to do. They don't want academic excellence nor do they have great passion in veterinary medicine and surgery. All these factors work to giving you the competitive edge. Just be proactice and just do it. If you want to achieve something, plan ahead, research and work very hard by practising a lot. There is no short cut to academic excellence and a Medal of excellence from the University.

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