Comprehensive Overview of Surgery and the Surgical Clerkship

Surgery is a branch of medicine that evaluates and manages diseases and injuries that need to be treated with an operation. The goal of surgery is to remove (e.g., appendectomy, resection of a tumor), repair (e.g., suturing a deep cut in the skin), or reconstruct (e.g., herniorrhaphy with a mesh graft) tissue lesions of any kind. It is a fast-paced specialty that requires very good collaboration of a multidisciplinary team, including surgeons, anesthesiologists, and operating room nurses, in order to function smoothly.

Surgical Specialties and Subspecialties

Surgery is divided into a wide range of specialties and subspecialties. Almost all surgical paths involve initially some training in general surgery. The diverse fields include:

• General surgery
• Vascular surgery
• Colon and rectal surgery
• Orthopedic surgery
• Pediatric surgery
• Neurological surgery
• Oral and maxillofacial surgery
• Otorhinolaryngology
• Plastic surgery
• Urology
• Surgical oncology
• Trauma surgery
• Transplant surgery

The Role and Responsibilities of a Surgeon

Primary role: It is a surgeon's responsibility to establish the diagnosis and indication, perform the operation, and provide preoperative and postoperative care for the patient. A “typical day” varies greatly depending on specialty, presenting patients, daily assignments, and shift plan.

The Operating Room and Urgency Levels

Surgeons spend a significant amount of time in the operating room (OR), where they perform procedures in a multidisciplinary team. Operations can be classified according to their urgency as follows:

Clinical Duties

On the hospital wards, surgeons are primarily responsible for postoperative patients, who need to be monitored for proper healing and any potential complications. In the outpatient clinic, surgeons see both preoperative patients to establish the indication for operation and postoperative follow-up patients. Additionally, surgeons do consultations for other specialties.

Essential Skills for Surgical Practice

For the management of surgical conditions, extensive knowledge of pathology and anatomy is particularly important. Diagnoses are established using clinical skills, such as history and physical exam (H&P), and diagnostic tools like imaging and laboratory tests. As surgical patients are often critically ill, surgeons need to be quick and confident at making important decisions concerning diagnostics and treatment. During procedures, surgeons are trained to work with focus, endurance, and precision. As a surgeon's work is often physically exhausting and stressful, it requires a high amount of resilience.

General Surgery Focus

The work of a general surgeon is typically very broad. They treat acute and chronic conditions affecting almost every part of the body, including the gastrointestinal organs, the abdominal wall, the endocrine system, the breast, the skin, and soft tissue lesions. General surgeons also manage a broad spectrum of trauma injuries and need to have a fundamental knowledge of other surgical specialties.

Typical procedures in general surgery include:

• Appendectomies and cholecystectomies
• Bowel resections and adhesion removal
• Nissen fundoplication and emergency laparotomies
• Breast biopsies, hemorrhoid surgery, and thyroid surgery

Surgery Clerkship and Career Training

The typical length of the clerkship varies between 8–12 weeks, depending on the medical institution. It is usually divided into 4–6 weeks in general surgery and 2–4 weeks in other surgical specialties. The rotation can comprise the inpatient service, surgical wards, operating room, and outpatient clinic.

Clinical Skills for Students

During the clerkship, students focus on gaining and displaying knowledge of the management of common surgical conditions. Key skills include:

• Performing an H&P with a focus on common surgical conditions.
• Presenting patient cases and writing notes.
• Becoming familiar with OR etiquette.
• Learning how to scrub in and maintain sterile fields.
• Assisting in surgeries, which can include suturing, retracting, and guiding the laparoscopic camera.

Regarding long-term training, residency programs in general surgery last a minimum of 5 years. Those who seek out further specialization can accomplish this via fellowships in areas such as cardiothoracic surgery, vascular surgery, or surgical oncology. After completion of their training, surgeons can choose to pursue an academic career in the hospital or go into private practice.