Plastics

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==== Expectations for Medical Students ====

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Recommended Apps:\\
Touch Surgery - Great overall resource for walking you through the steps of an operation and pertinent anatomy.\\
Complete Anatomy - A nice Anatomy Atlas for on the go on your phone.\\
Epocrates - Pharmacy app that is good for looking up medications and dosing.\\

The Things I Carried:\\
4 Color Pen: BIC 4-Color Grip Ball Pen\\
Flashlight: Streamlight 66118 Stylus Pro LED Pen Light with Holster, Black\\
Trauma Shears: Prestige Medical Fluoride Scissor, Black, 7 1/2 Inch (Amazon)\\
Stethoscope: Some attendings want this: Schulick, Vogel\\
Headlight: Useful on ENT\\
Reflex Hammer: Useful on NSGY\\

Great Resources:\\
In my opinion you need 3 things to be successful studying. Don’t go chasing too many other things to read:\\
1. Question bank: U-world is terrific. I recommend doing at least two NBME exams during your surgery block.\\
2. All inclusive go to resource: medbullets.com. This also has an accompanying premium version with good questions and it’s not too expensive. This website has everything you need for “pimp questions” and the tests. I don’t recommend chasing things further than this.\\
3. Passive learning through onlinemeded.org - these videos are gold. Watch them all for each rotation you are on.\\

To look up the cases for the week, go to EPIC -> Schedule and enter then following attendings. Make sure you choose All Departments. You are expected to have read about the patients and each case the night before. In the morning, you will get asked what cases you are doing for the day.

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==== FAQs ====

Frequently Asked Questions:\\

**The List**\\
- What should I be printing out? Both the "current list" and "handoff".\\
- Where do you prefer us to write the vitals and updates? On the "Handoff."\\
- Do you prefer the list stapled? yes\\
- Is it okay to help update the list? Yes, it is your job to add patient's to the list that you are operating on and help update the list with the intern after rounds.\\

**Rounding**\\
- Should I pre-round? Yes, we expect you to see your patient that you will present on rounds. You should be ready to present a 1-liner on your patient, overnight events, vital signs and labs, pain status, diet issues, urine and foley status, anticoagulation plan and antibiotic plan. This should be followed by your plan for the day.\\
- I feel like I am in the way on rounds. How can I be helpful? I too felt in the way as a medical student. Personally, I stuffed a bunch of gloves in my pocket and had a bottle of hand sanitizer clipped to my jacket. The best way to be helpful is to pay attention to what is in the dressing coming off and then to be ready with the same items to hand to us. Patient's with flaps will always need the doppler ready.\\
- Where can I get dressing supplies? You will be carrying around the dressing supply bag which is kept in the resident room. It is your job to stock this daily. It is a good idea to go "shopping" on the 6th floor med rooms to stock the bag.\\
- What are the basic dressing supplies? Kerlix, 4x4 gauze, Medpore tape, ABD pads, ACE wrap, bacitracin, cotton applicators (q-tips), 1/4 inch packing, tegaderm, biopatch, marking pens.\\
- What does ABD and ACE stand for? ABD is an old acronym for Army Battle Dressing. ACE stands for All Cotton Elastic. These are common pimp questions that you will be asked.\\
- Should I really lead rounds? Having the medical student help lead rounds is unbelievably helpful. Our patients are all over the hospital and it's easy to miss people. Knowing where we are going next as we are leaving the room will make you very useful. You can help grab the elevator or help get isolation gowns out.\\

**OR**\\
- How do I help get the patient ready for the OR? Make sure you read about the patient and know the PMH/PSH and reason for their operation. Ask the nurse if they would like help transporting the patient to the OR. Almost all cases will have arms out. For breast cases, the arms need to be wrapped. Most people use kerlix, Dr. Mathes uses cast padding, Dr. Livermore uses blankets. First pad the arms with purple foam. Make sure the SCDs are ready on the bed. Help get the bed in and out of the room. Help anesthesia get set up. You can help them set up the extra IVs or a-lines. Makes sure you give the circulator your gloves and gown and write your name on the board under medical student.\\

==== Previous Feedback ====

I would watch youtube videos the night before of each procedure and review the anatomy. For understanding post op care, I thought Pestana’s surgery notes were useful. Touch surgery app was excellent but they didn’t cover many of the cases I saw. I would also note to prepare for multiple of your teams attending’s cases as your day can vary. Overall I think spending a time at night made the OR educational even if I wasn’t actively involved and amazing when I was. \\
--\\
My only feedback is that the basics of dressing changes were new to me since I haven’t gone through gen surgery yet so I don’t know if you know of a good resource with the basics of dressing changes and materials but that was something that might be helpful. In terms of resources I think it would be great to include Michigan and Janis because they got me through many of the basics of all of the procedures I saw. I think that having high expectations of us is really valuable in preparing us and helping build our knowledge and confidence during third year and moving forward.\\
--\\
 

==== Heslop's intern guide to other interns ====
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==== Advice from Past Medical Students ====
If you are a medical student who has rotated with PRS, please add something here. It can be something you learned, coffee/food recommendations around the hospital, things to do to impress nurses/residents/attendings, or quotes from residents or attendings that stuck with you.

//Nicholas R W Cleland, Class of 2023//\\
Plastics is a surgical field that has an incredible amount of variety. Try and see as many different kinds of surgeries as you can. Since you also need to get evaluations from attendings, it is also a good idea to spend a lot of time working with one or two attendings. This is also a great time to learn general wound care. Sure, being in the OR and learning the steps to a DIEP are cool, but learning how to change a wound vac is more likely to benefit you in the future.\\

If you haven't already, get compression socks. You will spend a lot of time standing and your feet will be swollen by the end of the day. I also recommend getting 3-5 scrub caps depending on how often you do laundry. I would also recommend getting a qbank on your phone so you can do practice questions in between cases. The Michigan Manual of Plastic Surgery is also nice to have on your phone so you can do some reading on a procedure before a case. A pdf version can be found in the Media Manager of this wiki (upper right corner).\\

When you are holding a flap for a resident or an attending, the goal is to maximize THEIR view, not yours. Hold it so they can see what they are doing.\\
"It is not for you to see."\\
Dr. Kaoutzanis \\

If you see something that you think is wrong or off, say something. The most important person in the room isn't the attending, it isn't the resident, it isn't you, it's the patient. \\
"Don't be scared to speak up. The most important person in the room isn't Dr. K, it's the patient."\\
 Christian the scrub nurse\\

__Pimp Questions:__\\
What are the stages of skin graft healing?\\
Diffusion: skin graft acquires nutrients from nearby areas, but not from extant blood vessels. This keeps the graft alive during days 1-2.\\
Imbibation: skin graft begins to acquire nutrients from extant capillaries, but the capillaries are not yet lined up. Days 2-3.\\
Inosculation: capillaries in the graft and the recipient site line up. Days 3-4. \\
Revascularization: skin graft becomes vascularized. Day 5.\\
(The answer changes depending on who you ask, but if you get asked this, this is a good answer.)

What are the layers of the abdominal wall?\\
Above the arcuate line: Skin, subcutaneous tissue (Camper's fascia then Scarpa's fascia), external oblique aponeurosis, internal oblique aponeurosis, rectus muscle, internal oblique aponeurosis, transversus abdominus aponeurosis, transversalis fascia, extraperitoneal fascia, peritoneum.\\
Below the arcuate line: aponeuroses of external oblique, internal oblique, transversus abdominus are all shallow to rectus muscle.\\

What are the anatomical borders of the breast?\\
Superior: clavicle or 2nd rib\\
Inferior: IMF (inframammary fold) \\
Medial: sternum \\
Lateral: latissimus dorsi\\
Deep: pectoralis major \\

What is the blood supply of the breast?\\
Internal thoracic artery, intercostal arteries, lateral thoracic artery, thoracoacromial artery. \\

Why do we de-epithelialize a flap for a DIEP or the skin under a nipple for a nipple reconstruction?\\
The natural life cycle of the epidermis is to slough off. If you leave the epidermis there and then put it underneath more skin, you can end up with a cyst.\\

What plane do we put a TAb block in?\\
TAb = transversus abdominus. The block is put in the transversus abdominus fascial plane with ultrasound guidance. \\

Why do you remove erectile tissue from the penis when making a neo-vagina during a vaginoplasty?\\
If the patient were to get an erection after the procedure has been completed, you could tear sutures or damage the neo-vagina.\\