VA Surgery

[chase]

VA Surgery was a good learning experience. You have clinic three days a week: afternoon on Monday and all day on Tuesday and Friday. Wednesday and Thursday are solely surgery days but there are operations on the three clinic days.

The service is split into Vascular and GI. The current GI attendings are Dr. Rivera (head), Bowden, and Holsten. The Vascular attendings are Dr. Griffin and Ramirez. You'll work with a 5th year chief resident who primarily does surgeries and oversees everything, a 3rd year resident who does consults, a 2nd year resident who covers the LSU (life-supports unit, i.e. ICU), and a surgery intern and family medicine intern who help cover the floor patients.

You might be required to do one 5 minute presentation for the required Vascular conference on Thursdays at 7:30am, but it's a relaxed session and everyone's more worried about the resident's presentations.

It's a big ship and things often are confusing at first but you'll see that things work well after a while at the VA for all the juggling that must go on.

PROs:
You'll learn great physical diagnosis skills in the Vascular Clincs: you'll master PVD, ABI with doppler, diagnose AAAs, and see carotid doppler studies and listen to tons of bruises. Drs. Griffin and Ramirez are good teachers and they're both nice.

There has to be a student in EVERY case and you scrub in--you'll generally do more here than any other MCG general surgery rotation. You'll probably only scrub in to 15-20 surgeries but you actually get to do stuff and are taught well. There's very little pimping that goes on...

You get continuity of care with your patients being taken care of and seeing their surgery. You pre-round at 6am, seeing all your 1-5 patients. Most of the VA surgery patients are very, very greatful and pleasant.

You get four-five days off and most of the time they want you gone post-call at noon. They're real relaxed and let the chief resident handle things as happens with a lot of stuff.

You get to really contribute to care by doing procedures like NG tubes, dressing changes, hardware/software removals, sample collections, etc. You'll order lots of things on the computers at the VA and everything is on them which is very convenient.

You'll learn to diagnose and do lots of good exams in the GI clinic: hernia detection, hemorrhoids, and colonoscopy watching.

Cons:
Since you have to be ready by 6am and see all your patients, some people get there at 4:30am and you generally leave around 6pm every evening. It may be long hours but it's usually NOT intense.

VAisms. There's a constant air of discontent in the VA. Attendings, Residents, etc everyone complains about the VA. It can occasionally be a downer, but generally the attendings really love what they're doing--both Vascular guys were from private practice but chose to take less money to come here to teach and be involved in Veteran's care. The Nurses are the biggest downers--they can be jerks and know they'll never be fired so they do just enough not to get written up... too often.

Summary and highlights:
Dr. Holsten seems to be the most involved in student grading. He's the youngest and seems standoffish at first, but he's actually very personable and likes teaching/working with students. Make sure you make time to be around him as he is so busy.

Whatever prejudices you have about working at the VA or with the system, it's not what you think. I feel like it's run a lot more efficiently than my other surgery experiences at MCG. They let you do a lot at the VA (as much as you volunteer and show enthusiasm in doing) and having all the residents/interns to work with makes for a fun time. That way, even if there's one resident/intern that rubs you the wrong way, you can still hang with the others and work mostly with them.

[chuang05]

I don't like VA at all, although most of the problem is probably because of me. But I feel that the residents are not clear about what they expected of you at all and there seems to be an air of annoyance with us leaving after post-call. I also feel that the residents can be rather intimidating at times.

But then again, I think it is mostly because of my personality.

[Peggy Sue]

Ditto a lot of what was said: long work hours but you can actually get good hands-on experience. The learning curve is steepest for getting efficiency (totally forget the super-long internal med write-ups). I always got good feedback on what I needed to work on (and by good, I mean accurate since they will point out stuff, but it was really helpful in being able to improve by the end of the month). Just remember to have a little bit of a humble but tough skin, and you'll find that the group is pretty easy to work with (despite the exhaustion ).

The biggest drawback is delay in getting access to the computer system. Check every day about that, and if you can, borrow a friend's access to at least be able to look up vitals in the morning. And seek out extra computers that are available at 5am (down the hallway, on the floor, wherever).

[gkalv]

most of that above is still the case at the va. 2 weeks vascular, 2 weeks general surgery, most of which is gi - i saw mostly hernia repairs, an LAR (low anterior resection for colon ca) and some misc stuff. on vascular they did a couple BKA's (below the knee amputation) and several grafts for dialysis.

now-a-days dr. griffin is officially in charge of student evals, so make sure you work with him when you're in vascular clinic, ask questions, etc. he pimps a little in the or, but nothing major. other attendings have input to your grade.

you will do a presentation at vascular conference, 5-10 minutes, dr. ramirez will give you a topic and approve your slides a day or two before hand - one slide will be on the history of whatever problem you're presenting. the conferrence is nice b/c they have muffins and dounuts - review vascular anatomy esp if your on vascular b/c griffin will ask you which artery is which, etc. why don't we see any bones? - they are digitally subtracted out of the image (he asked us that almost every week).

monday am is m&m and general science conference for all gen surg residents - a nice way to ease into the week.

for me, i did very little in the OR besides holding retractors. maybe part of that was me, but in my 2 weeks of subspecialty (ortho and ct) i did a lot more. i didn't even suture at the va.
you will be asked to get vitals and labs on each patient and you will follow all the patients, so if there are 2 students and 12 gen surg patients you'll see 6 and write notes on each in the am. i got there between 5 and 5:30 and i usually had enough time.
dr. holsten can seem a little harsh at first but if he's hard on you with the pimping it's because he wants you to do well. make sure you read about your patient's disease for rounds - which might not be until 5 or 6 in the afternoon. he will pimp you. you'll also most likely pre-round with the residnets in the am. holsten is actually a really cool guy and makes lots of jokes.

on vascular, we hardly ever rounded and clinic was thrice a week, only 1.5 days/week on general.