Top Tips for Budding Surgeons in Foundation Training
There will be another amputation, don’t worry. We’ll keep a look out for you.” I forced a smile as I removed my surgical cap. “Thanks”, I nodded towards my SHO. He had stayed behind with me hoping to amputate a gentleman’s gangrenous big toe. The theatre was free, the surgeon was ready, the assistant (me) was very keen and ready, but after-hours staffing shortages had thwarted our efforts. Amputations themselves are surprisingly swift. A below knee amputation can take 2-3 hours, an above knee 1-2 hours, and a toe amputation, just 5-15 minutes. 15 Minutes was all I asked for. Of course, that didn’t include the general anaesthetic, time in recovery, and other essential steps… Steps our patient likely wouldn’t want us to skip.
15 minutes was what I was told at least. As a junior doctor working in Vascular Surgery (where more than half the patients had parted ways with a body part) the information I relayed to patients was generally recited from textbooks or seniors, rather than from first-hand experience. I felt ashamed of not being able to describe in depth the very procedures we were preparing our patients for. (Though understandably, most patients preferred to avoid the grittier details anyway.)
Like many FYs, I was drawn to the operating room – a space to witness the transformation of theory into practice and sharpen my surgical skills such as suturing and handling instruments. Yet, the demanding ward workload often left me arriving at theatre too late or not at all. If I wasn’t struggling, I knew one of my colleagues were, and the guilt of going to theatre would creep in. Eventually, my voice became small. My ambition became exhausted. I became comfortable with the ward routine and my energy to seek surgical opportunities dwindled.
Instead, I’d settle for listening to our SHOs tell tales of their travels to theatre while huddled in the doctor’s office, as if gathered by the bonfire to share mythical legends and lore. Our ward, albeit hectic, was an enjoyable one to work in. As we approached the end of the surgical block, we reflected on our successes and regrets. It dawned on us that we FYs were all in the same boat – we each harboured a curiosity that kept us wondering what it would be like to step into the role of a vascular surgeon.
We decided to declare our desires to join theatre to anyone who would listen: consultants, SHOs, HCAs, ward clerks. We combed through theatre lists daily and prioritised jobs accordingly. We cross-covered over 3 different wards to make sure no-one was struggling before someone headed to theatre. Soon, it became a running joke that we were all looking for toes to amputate. Our vigilance occasionally paid off, allowing us to seize some golden opportunities. Yet despite our efforts, the numbers of afternoon amputations seemed to decline. Some nurses joked about donating their own healthy toes if it meant giving us the experience we sought. “There must be a reason why we are born with ten toes after all”, they jested.
Finally, my moment arrived. A gentleman needed an urgent above knee amputation and theatres had sent for him at 3pm. Most of the jobs were done; all the discharges were prepared; and there were three other doctors in the office manning the ward. “Go!”, they exclaimed. I was more than ecstatic to.
That day, I observed my first amputation and performed my first vertical mattress suture on a real patient. Observing the careful, yet swift dissection of the fascia and muscles, assisting with tissue retraction to expose the bone prior to sawing through, and suturing the wound back up was exhilarating. The patient recovered well and I went home with a smile.
Now in my second FY1 rotation, I’ve learned the importance of actively pursuing opportunities. They’re often elusive and we may feel like we’re left all alone, but with intention and persistence, these opportunities can be found. I’m still searching and learning. But, here are my top tips for those seeking surgical exposure:
- Get Involved with Surgical Societies: Join your university surgical society or other surgical society like ASiT. Committee roles enhance your portfolio and demonstrate your interest in surgery, making it more likely for surgeons to involve you in theatre. Affiliate membership to the Royal College of Surgeons Edinburgh is free for students and junior doctors if you attend certain events.
- Organize or Join a Surgical Skills Club: Practice basic surgical techniques to build confidence and competence. If there’s a gap in training, even consider organizing your own surgical skills course with a consultant’s approval.
- Invest in a Surgical Skills Kit: These kits, often available through societies or online, allow you to practice at your own pace. You can get one from Amazon for around £30. Some theatres may have expired equipment or sutures to practice with – always ask before taking any.
- Utilize Free Online Resources: Platforms like YouTube and free resources like SutureUK provide tutorials on basic techniques and their applications. The best thing is that you can go at your own pace.
- Attend Conferences: Conferences are great for learning, networking, and gaining inspiration. Student conferences as a medical student tend to be free or very low cost. Bring friends or meet like-minded peers to stay motivated.
- Share Your Passion: Let colleagues and mentors know your aspirations. You can create opportunities for everyone to learn by working together!
- Seek Additional Exposure: Email consultants and ask to shadow them. As an FY, use surgical rotations to their fullest and consider arranging taster weeks if surgery isn’t part of your schedule.
Finally, remember that persistence is key. While it might feel like opportunities are scarce, they’re often closer than they seem. The surgical staff I encountered were all so supportive and were even delighted to see FYs venture into theatre. Keep trying, stay vocal, and remain ambitious – sometimes the opportunity will come and seek you.
Sophia Wong Ching Hwai
F1, North West of England Foundation School