...What it takes to get into a General Surgery Residency . . . . By Shirin Towfigh, MD -----------------------------------------------------------------------------------------------------------A word to the wise: Only those who cannot envision doing anything else with their lives should choose surgery. If you can find happiness in any other career, then do not choose surgery. A few statements I stand by (let’s get rid of some myths): 1. It is never too late to choose surgery as a career. Many do not choose until the end of their third year. 2. Though most students who know they are interested in surgery do it as their last rotation in Year III, whether you do surgery first or last has historically had no effect on your grade or outcome. 3. If you are savvy in your rank list, you will likely match in a program. Most don’t match because they did not rank enough programs (or the right programs). Be honest about your prospects and have a mentor. 4. The majority of general surgery programs are very good. You will graduate being a good surgeon and you will get a good fellowship or a job. Now, the facts (from NRMP book, found lying around in the KSOM Student Affairs Office): In 2004: - 1,042 of 1,044 general surgery spots were filled. The remaining 2 spots filled the day after the MATCH. - Of U.S. grads, 885 matched out of 1,230 applicants (72%), the rest were foreign grads. Note that the national average for all specialties is a 93% match rate. - The average student ranked 12.4 programs...
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...Dontavia Zeno English 1157-002 Past the Scalpel Nora Steiger 05/01/2014 Dr. Joshua Landes is a board certified general surgeon, who received his premedical and medical education at Brown University. He completed his residency at Tulane University School of Medicine, and is a member of the American College of Surgeons. He now works as one of two general surgeons for the Hamilton Medical Group in Lafayette, Louisiana; which is where our first interview took place. I remember sitting in his office waiting for him to come in, and staring at a coat rack located in the corner. It held only two white lap coats, which looked as if they hadn’t been worn for some time; there were no rumples or creases out of place, and as crisp and wrinkle–free as they were, you could assume they came straight from the dry cleaners. It also held a green scrub cap that was obviously worn quite often, which actually looked slightly yellow due to it being washed so many times. Directly across from the coat rack stood a bookshelf filled with books that all contained the word “surgery” in its titles. The books were triple the size of a holy bible, and weighed so much that the shelves bent downward, like a meniscus in a graduated cylinder. When he walked in I noticed he wasn’t wearing a white lab coat, so I asked him about it. “I don’t need a lab coat to remind me that I’m a physician,” he said as he smiled and took a seat behind his desk. That’s when I realized my hypothesis of who I thought...
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...Many people with HMO will have a surgery at some point in their lives. This will cause them to have a surgical scar which some people might have a hard time accepting. In Steven Petrow’s article “Learning to Accept (if Not Love) My Scar” he talks about learning to accept his scar. Petrow got his scar after having surgery to remove cancerous lymph nodes from his abdomen. The surgery resulted in a scar along his abdomen. When he first got the scar, he had a hard time looking at it and struggled to take his shirt off infront of others and himself. Eventually Petrow’s scar became a reminder of his survival. It was slow for him to accept his scar but it eventually became a “talisman of sorts, a visual and lasting connection to my own history” (4)....
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...innovations in medicine today is fetal surgery. Fetal surgery is an exciting, accurate, and sharp new technology and in particular the surgery they use to help myelomeningocele. It is more advanced than other surgeries and takes more time. It also uses an extensive amount of doctors. Fetal surgery for myelomeningocele (MMC) needs more specialists and surgeons in the OR compared to other surgeries. Spina Bifida Spina bifida is the most common neural tube defect (NTD) today. According to the March of Dimes, “About 1,500 to 2,000 babies are born with spina bifida each year in the United States.” (What is SB, 5). A defect forms in the spine before birth and causes a hole to be left open in the spine. Spina bifida is broken...
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...Robotic Surgery Technology, Society, and Culture HUMN432 Introduction: Robotic Surgery Robotic surgery is the latest development that uses robots and computer aided apparatus to aid in normal surgical procedures. It is a new technology and mostly used in well-developed countries. With robotic surgery a single surgeon is able not only to perform multiple surgeries but also do his/her work from any part of the world (McConnell, Schneeberger & Michler, 2003). Robotic surgery is a type of procedure that is similar to laparoscopic surgery. It also can be performed through smaller surgical cuts than traditional open surgery. There are small precise movements that are possible with this type of surgery. It gives some advantages over standard endoscopic techniques. Sometimes robotic-assisted laparoscopy can allow a surgeon to perform a less-invasive procedure that was once only possible with more invasive open surgery. Once it is placed in the abdomen, a robotic arm is easier for the surgeon to use than the instruments in endoscopic surgery. The robot reduces the surgeon’s movements. The robot assistance reduces some of the hand tremors and movements that might otherwise make the surgery less precise. Robotic instruments can access hard-to-reach areas of your body more easily through smaller incisions compared to traditional open and laparoscopic surgery. This procedure is done under general anesthesia where you are asleep and pain free. The surgeon sits at a computer...
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...------------------------------------------------- Robot Assisted Surgery: The Evolution of the Surgeon and the Operating Room Abstract The art of surgery has evolved significantly from the times of shaman priests in ancient Egypt and bloodletting barbers of Medieval Europe. This evolution was assisted by the development of new tools that were created as the result of some advancement in technology. These new instruments permitted the surgeons of their day to unlock new possibilities and develop new techniques, each more sophisticated than the one before. Due to the sensitive nature of surgery, moral and ethical obligations were established early on and eventually formed the basis of “The Hippocratic Oath”, which is still relevant to the modern surgeon. We are now in a place in history where robots are being used to assist with surgical procedures that were once only conceivably done by human hands. This paper seeks to detail this evolution as well as describe current and future applications of robotics in the surgery and the ethical implications inherit with this technology. This report will also attempt to identify and discuss the complex legal, political, and cultural issues that have also evolved with this science. A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications. This most recent development in surgical advancement has infinite potential...
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...ranging from the history and development of robots that can be found in surgical rooms, political concerns regarding the Food and Drug Administration and their requirements to approve use of these robots, the legal aspect of robotic technology on how to determine which party is held liable in case of accidents or malfunctions that can lead to injury and a legal case that shows the difficulty to prove fault against a manufacturer. Also discussed will be the economic ramifications on our society, psychological, sociological, cultural, moral and ethical impacts on human life, in particular the patients that undergo surgery involving a robotic surgical system, and the environmental impacts of robotics in surgery. It is our hope that through this research paper that we are able to explain to and educate our readers on the impacts of Robotic Surgery as this type of surgery is becoming more popular with doctors in order to...
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...greater Columbus, Ohio. Twin Oaks is the 2nd largest hospital in Ohio. We are also ranked in the top 5% of the hospitals in the United States according to the U.S. Health Grades website. Twin Oaks has a level one trauma center that has 852 beds in all, to accommodate the patients that need our services. Being a level one trauma center we receive all of the more extensive cases and life threatening illnesses that our fellow hospitals can not accommodate. We have 6 beds set up in the emergency room to be able to perform emergency surgery at the bedside. This helps us give the patient who may not have the time to be prepped for surgery get the care they need immediately. In order to be considered a level one trauma center, we have to have 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care. At the medical center, we have also incorporated a comprehensive quality assessment program in order evaluate and improve patient care and wait times when they arrive at the emergency room. (http://www.amtrauma.org/?page=TraumaLevels) Twin oaks offers a full range of diagnostic, medical and surgical specialties in areas such as emergency medicine and trauma, heart and vascular, oncology, orthopedics, neurology, and women’s and children’s services. We are committed to...
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...Treatment of bosom malignancy Four sorts of standard treatment are utilized: 1. Surgery Most patients with bosom malignancy have surgery to expel the growth from the bosom. The fundamental objective of surgical treatment is to evacuate the growth and precisely characterize the phase of infection. Surgical choices extensively comprise of bosom protection treatment taken after by radiation treatment. Bosom rationing surgery, an operation to evacuate the growth however not the bosom itself, incorporates the accompanying: (a) Lumpectomy: Surgery to expel a tumor (irregularity) and a little measure of typical tissue around it. (b) Partial mastectomy: Surgery to expel the piece of the bosom that has growth and some typical tissue...
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...The career of my choice is an anesthesiologist. I have always found a great interest in the medical field and specifically in anesthesiology. Anesthesiology is the part of medicine that focuses on anesthesia and anesthetics. Without it, surgery would be painful and unbearable. An anesthesiologist is a physician who administers anesthetics before,during, or after a medical procedure. There job is develop a plan for their patient and to be there during and after their surgery. They make sure that their patient is comfortable for surgery by general anesthesia or regional anesthesia. General anesthesia is when the patient is heavily sedated to the point where they are unaware, while regional anesthesia is numbing the part of the...
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...nursing practice. How we practice as nurses is often dictated by new policy and guidelines which are brought about by the evolving healthcare system. For an issue to be contemporary it has to be occurring in the present and in the sense of nursing it would seem that many issues could be deemed as contemporary due to the ever fluctuating nature of our healthcare service. For the purpose of this assignment I am going to address the issue of pre-operative fasting and the tradition of fasting patients from midnight until surgery the following day. Evidence suggests that this practice is outdated and unnecessary but still the practice occurs on many surgical wards. I aim to explore the reasons why patients are still subjected to unnecessarily long fasting times and how we as nurses can change this outdated practice. I have chosen to look at this area of contemporary nursing because as a student nurse I have had practice experience in both a surgical ward and general theatre. I feel that having had experience in both of these settings I would be able to link theory to practice experience. Fasting patients from midnight before day of has long been a time honoured tradition. The main reason for the nil by mouth rule from midnight has been to ensure an empty stomach at time of anaesthesia. If the patient is not fasted, gastric contents could be inhaled by the patient while they are under anaesthetic. Because the contents of the stomach are acidic it is important that regurgitation...
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...Trinity Hospitals five year plan includes development of an orthopedic center, cardiovascular center and a cancer center. Task four asks for an assessment of the viability of one of these service lines. By assuming the role of the hospital CEO, I will evaluate the orthopedic center service line and present the findings to the board of directors for their approval. Demand for Orthopedic Service Line As identified in the Trinity Community Hospital’s Community Needs Assessment, the demand for orthopedic services in the area is expected to increase by 46% in the next five years. Inpatient joint and spine procedure are projected to increase by 30% and outpatient joint and spine procedures are expected to increase by 350%. Trinity Hospital’s fact sheet does state that there is no formal orthopedic service at the hospital but there is strong interest by local orthopedic groups in joining the hospital’s team. There are plans to build a new 15,000 square foot physical therapy/rehab center on or close to campus to support the new orthopedic service line. This is important as appropriate follow up can be offered to orthopedic patients. Trinity Hospital must rise to meet their competition. Tertiary Medical Center boasts a strong orthopedic program and a trauma center, while Regional Hospital also boasts strong orthopedic services. The hospitals five year plan calls for distinctive clinical programs and services in the areas of spine, total joint and hand services. Also, the plan...
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...pressor response to intubation. Esmolol is effective in controlling both heart rate & systolic BP than others.Taittonen et al31(30) in 1997 concluded that both clonidine & dexmedetomidine decreased peri-operative oxygen consumption effectively with a similar hemodynamic profile in plastic surgery cases under GA. In 1989, Kallio et al(31) studied the effects of dexmedetomidine on haemodynamic control mechanism. . As part of a placebo controlled study Dexmedetomidine was administered to five healthy male volunteers in single intravenous doses of 12.5, 25, 50 and 75µg over 30 seconds. Blood pressure, heart rate, impairment of vigilance and sedation score were measured. Authors concluded that higher dose of dexmedetomidine (50 and 75 µg) decreased blood pressure and heart rate with initial small hypertensive response due to activation of postsynaptic α2–receptors. The administration of single intravenous doses of dexmedetomidine resulted in total inhibition of norepinephrine levels. In 1990, Aanta et al(32) conducted a randomized double blind controlled study to know the effect of dexmedetomidine on vigilance, thiopental requirements and haemodynamic, catecholamine and hormonal responses to surgery in 40 ASA I non-pregnant women scheduled for dilatation and curettage (D and C) of uterus. Authors concluded that dexmedetomidine, as preanaesthetic medication decreases thiopentone requirements and improves the recuperation from anaesthesia with no serious haemodynamic or other adverse...
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...Research Utilization Project: Early mobilization in pediatric cardiac surgical patients Theodore R. Dage University of Florida Abstract Prolonged sedation and mechanical ventilation in the ICU setting has the potential for negative effects in the pediatric post-surgical period. A systematic review of the literature reveals a lack of high-quality recent research into the feasibility and benefits of an early mobilization protocol in this population. A PICO question will be stated to guide research, and an examination of the existing research on the subject discussed. The author will demonstrate the justification for further research into such a protocol. Research Utilization Project: Early mobilization in pediatric cardiac surgical patients Mechanically ventilated patients in the adult ICU setting frequently experience prolonged periods of immobility and sedation (Schweickert et al., 2009); this is also the case in the pediatric post-surgical population. Prolonged pharmacologic sedation is associated with significant adverse sequelae (Wolf & Jackman, 2011). Early extubation and mobilization of cardiac surgical patients has been shown to reduce postoperative complications and shorten length of stay (Pande, Nader, Donias, D’Ancona, & Karamanoukian, 2003). The research question generated to examine a justification for a clinical research project is stated in PICO format as follows: In pediatric patients aged 6-13 (P), does a protocol of early mobilization...
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...is Shouldice Hospital? Shouldice Hospital is a highly successful business that maintains a focused service delivery system due to the success rate of its surgeries, its low employee turnover, its ability to maintain high quality standards, its ability to keep costs low and to remain profitable, and most especially the positive evaluations of its patients. Its strengths can be attributed to stringent policies of staff training in the Shouldice surgical method; the preservation of a communal atmosphere amongst both the staff and with the patients; the implementation of efficient and cost-effective facility operations; and high demand for operations. Its less successful aspects include: an inability to serve a considerable unsatisfied demand, as it is operating at near-full-capacity in its present facility; limited marketing; and an inability to prevent proliferation of its surgical techniques. 2. What Accounts for Shouldice’s Performance? a. Unique Operating Techniques Shouldice has vertically integrated nearly all operational functions in an effort to tightly control its distinctive techniques for performing hernia operations, as well as for pre- and post-operative patient care. The hospital has been remarkably successful in its ability to provide its patients with a quick, quality, low cost surgery in a comfortable environment, and has enjoyed an operations’ success rate exceeding 99%, compared with an industry average of approximately 92%. 1 ...
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