Suggested Books To Read During Your General Surgery Residency (Read More)
Bailey & Love's Surgery, 27th Edition Surgery Essence by Pritesh Singh (PGMEE) Sabiston's Textbook of Surgery
Farquharson's Textbook of Operative General Surgery, 10th Edition Surgery Sixer for NBE by Rajamahendran Surgery PreTest Self-Assessment and Review, Thirteenth Edition



Indian Medical and Surgical Superspecialty seats

By this recent trend of superspeciality seats going empty shows that there is something is going really wrong in the medical higher education policy.

 Amongst the surgical branches, the ones which are majorly impacted are CTVS surgery on the top, followed by paediatric surgery and plastic surgery.

Amongst the medical branches, cardiology on the top, followed by critical care, nephrology and gastroenterology. Below is my analysis of possible causes of this trend:

Widespread prevalence of unreasonable service bonds by the state governments for candidates joining super specialty seats: 


To join a super specialty seat there is already requires so much sacrifice which is made by the candidates on economic, family and personal front but by bringing the draconian service bonds into picture it becomes all the more difficult and counterproductive to join a superspecialty.

Government colleges in different states ask students to sign bonds to serve in their hospitals for a minimum of three years and a maximum of 10 years after finishing the course. For instance, Tamil Nadu wants a candidate to work in the state for 10 years; only then a candidate can practice on his own freely. Already the average age at which a candidate joins is 32-35 years, by the time a candidate finishes his bond service, he would be approaching the age of retirement or would in a grip of some lifestyle disease having wasted all the happy years of his/ her youth.


Inhuman working conditions and impossible number of work hours with all the responsibility


With no regulations on work time for resident doctors in place, in most states the residents have to do duties ranging from 24 to 48 hours at a stretch and monthly number of working hours ranging from 400-500 hours, which is highest amongst any of the developed or developing countries in the world. Owing to lack of specialist doctors, superspecialty residents have to virtually bear all the workload in these specialty institutes or departments with all the responsibilities. Family responsibility and personal mental and physical well being tends to be totally neglected for the whole 3 years.


The specialties affected more are the ones which are more physically demanding or are perceived to be with low scope


Specialties like CTVS and Pediatric Surgery are perceived to be more physically demanding. CTVS is mostly concentrated in big cities because of a costly setup (requirement of heart lung machine, ECMO machine etc), hence also contributing to lesser new job opportunities compared to other branches. 

Whereas with Paediatric surgery the issue is different, it is in a gray zone where in a lot of patients can go to a General surgeon or a super specialist as per the system involved. Corporate hospitals also do not support Paediatric Surgery as it is not so lucrative for them. Most of the Government Medical Colleges also do not have a Paediatric Surgery departments. Hence greatly limiting the opportunities for a freshly passed out graduate. However, gradually the demand of Paediatric Surgeons is definitely on a rise in Tier 1 and Tier 2 cities. 

Similarly for plastic surgeons there are not many positions in corporate hospitals compared to Urology, Surgical oncology, Gastrointestinal surgery or Neurosurgery. One reason for this is a lower case loads and the practice is mainly dependent on referrals from  general surgeons, oncosurgeons, orthopedic surgeons and pediatric surgeons. You have to work under the shadow of a senior surgeon for few years in corporate hospitals before you can kick start your own practice.

Surgery residency is one of the most exhilarating phases of every surgeons's life. Negotiating a residency requires a great deal of courage, hard work, diplomacy and skill. In a series of posts over the next few weeks we will be discussing various aspects of surgery residency aimed at residents in surgery and surgery residents.


DEVELOPING AN IMPECCABLE WORK ETHIC


When we discuss  post-graduation in surgery, the first word that comes into our mind is dedication. The only way to impress your seniors and inspire your juniors is to develop an impeccable work ethic.

PUNCTUALITY

The most important part of work ethic is punctuality. Make it a point to come early to work and take pride in the fact that you are the first to come. Coming early saves time, makes you more efficient and allows you to complete work as soon as possible. It also sets the standards for rest of the unit. We often find that residents who come early to work are often the ones who examine patients in detail and are the earliest to detect complications.

GETTING ORGANISED

Organising your work helps you finish you work faster and also gives you time to introspect and spend some minutes on academics. 

How to be efficient in residency

  • List out your tasks in a notebook(digital/pocket) - you will not miss out on important tasks
  • File important papers and classify them. For ex: I used  a file in which I kept my consent forms, insurance forms, investigation charts and patient reports neatly labeled and readily accessible. 
  • Make sure you complete your tasks in order of priority. For ex: starting a dopamine drip is more important than discussing the CT report with the radiologist
  • Don't take pride in staying up late and loitering around the wards handling files and records. An efficient surgeon finishes his scut work soon and spends time with patients not files.
  • Never postpone work. Postponed work often piles up.
  • Learn to delegate work - simpler work can be given to junior residents and interns.
  • Treat your juniors well - Happy juniors translates into faster and more efficient work.

PREPARING FOR SURGERY

A capable resident always is prepared for the procedure. Make sure you study the procedure in detail. Arrange the appropriate sutures and instruments in advance. Discuss with the consultant and the staff nurses if any staplers or other instruments are necessary. There is no substitute for good preparation. 
Before you scrub up for any major surgery, do watch some videos of the procedure.


We will be discussing more about residency life in further issues








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New group starts from October 15th 2019

New members will be added from October 15th 2019

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Keywords: Residency, Clinical Surgery, Surgery Life, Surgery in India, Surgeon in India, Surgery Residency, Association of Surgeons of India, Best Surgery Books




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BEST MCQ BOOKS FOR GENERAL SURGERY FOR INDIAN PG AND SUPER SPECIALITY EXAMS


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NEW Research in The Lancet | CRASH-3 trial provides evidence that tranexamic acid, a low-cost drug, could prevent deaths from TBI by as much as 20% depending on severity of the injury https://ift.tt/2VVwbU1 Worldwide, roughly 69 million people will experience a traumatic brain injury (TBI) each year. CRASH-3 was one of the largest head injury clinical trials ever conducted and led by London School of Hygiene & Tropical Medicine showed that a low-cost drug could prevent deaths from TBI by as much as 20% depending on severity of the injury. Tranexamic acid (TXA) was most effective in mild-moderate head injuries but showed no clear impact in severely injured patients. It’s also safe to give and is most effective the earlier it is given. If TXA is given to all TBI patients immediately after injury, it could prevent tens or hundreds of thousands of deaths around the globe each year. via WSF Instagram
Diagram of Pupillary Light Reflex Pathway
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Anatomy of Basal Ganglia - Axial View

Structures generally included in the basal ganglia are the caudate, putamen, and globus pallidus in the cerebrum, the substantia nigra in the midbrain, and the subthalamic nucleus in the diencephalon.

Basal ganglia's primary function is likely to control and regulate activities of the motor and premotor cortical areas so that voluntary movements can be performed smoothly.

Dysfunction results in a wide range of neurological conditions including disorders of behaviour control and movement.

Those of behaviour include Tourette syndrome, obsessive–compulsive disorder, and addiction.

Movement disorders include, most notably Parkinson's disease, which involves degeneration of the dopamine-producing cells in the substantia nigra, Huntington's disease, which primarily involves damage to the striatum, dystonia, and hemiballismus


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