Does Urology involve a lot of fine surgery?

[PJB]

Sorry to bother everyone - I hope I'm not the only med student here asking this question, even if I might be the only (new) MS4.

I'm an MS4 and I'm trying to decide between Urology and Ortho. Obviously, it's pretty f'in late to make this decision, so I need to sign up for a SubI and scramble to find some aways stat. Unfortunately that doesn't give me any time to spend a week or two in each of those rotations to see which I like more.

I don't have great natural hand skills and I have a little bit of a natural tremor - so does Urology involve a lot of fine surgery? Obviously, the robot is very forgiving, and I'll improve with practice no matter what, but are there a lot of fine repairs or suturing needed in Uro?

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[porktaco]

You're going to need fine-motor skills in both ortho and uro. From what I've seen (albeit very limited), natural tremors in surgical residents can be tamed, with practice or with pharmaceuticals. Much of urology involves working near important vascular structures that demand careful fine-motor attention. I would imagine orthopaedics is the same.

If possible (i.e., a light afternoon on some other rotation), check out the OR schedule for the day at the public/county hospital your school is affiliated with. Pick a big uro case and go check it out. Do the same with ortho. Decide which one suits your style and just commit. Committing is one of the hardest things to do, but once you do it you'll be able to relax and dive into the application process.

As for the tremor issues -- see if you can practice suturing at home on chicken or pork from your local grocery store. Spend an evening on it and decide whether the tremor you have is something you think you can tame. Seek the advice of an attending (preferably someone in general surgery or ENT or another field you're not serious about).

Good luck.

 

[DoctwoB]

Sorry to bother everyone - I hope I'm not the only med student here asking this question, even if I might be the only (new) MS4.

I'm an MS4 and I'm trying to decide between Urology and Ortho. Obviously, it's pretty f'in late to make this decision, so I need to sign up for a SubI and scramble to find some aways stat. Unfortunately that doesn't give me any time to spend a week or two in each of those rotations to see which I like more.

I don't have great natural hand skills and I have a little bit of a natural tremor - so does Urology involve a lot of fine surgery? Obviously, the robot is very forgiving, and I'll improve with practice no matter what, but are there a lot of fine repairs or suturing needed in Uro?

Just a 4th year, so take my opinion FWIW. In my experience most uro cases aren't particularly delicate relative to other surgical procedures, but there certainly are exceptions like anastamosing pediatric ureters, or microsurgical cases like varicocelectomies or testicular sperm extraction. There's a wide range (as I'm sure there is in ortho and other surgical fields). That being said, a general adult Urologist shouldn't require exceptional fine motor skills beyond those of other surgical fields.

As the above poster mentioned, a minor tremor can be overcome with lifestyle changes (avoid caffeine), being calm during procedures, and good technique. Major ones may prevent you from doing surgery or require meds. Either way I would choose based on interest and passion, not which one you think is more amenable to your limited hand skills (which should improve during residency), unless it really is a major tremor.

 

[PJB]

Thanks, that was definitely helpful. I honestly don't think it's a major tremor, but there have been too many times I've given a SQ Hep injection, put in a Foley, or done a subcuticular stitch where someone - whether they be a doc, scrub tech, or circulator - has said something to the effect of "Oh, it's totally okay that you're nervous, it's never easy with everyone watching you!"

I can already see my tremor being a problem anastomosing pediatric ureters or doing microsurgery like you mentioned, but what I am most worried about is just a general hand clumsiness. Even during my surgery rotation, there were other students who had no desire to do surgery whatsoever who could still tie insanely beautiful knots and suture amazingly. Meanwhile, my knots are looser than a pair of old jeans on a patient who got a lap band, and my subcuticulars make the patient look like he was operated on by Zorro.

 

[rigid]

Thanks, that was definitely helpful. I honestly don't think it's a major tremor, but there have been too many times I've given a SQ Hep injection, put in a Foley, or done a subcuticular stitch where someone - whether they be a doc, scrub tech, or circulator - has said something to the effect of "Oh, it's totally okay that you're nervous, it's never easy with everyone watching you!"

I can already see my tremor being a problem anastomosing pediatric ureters or doing microsurgery like you mentioned, but what I am most worried about is just a general hand clumsiness. Even during my surgery rotation, there were other students who had no desire to do surgery whatsoever who could still tie insanely beautiful knots and suture amazingly. Meanwhile, my knots are looser than a pair of old jeans on a patient who got a lap band, and my subcuticulars make the patient look like he was operated on by Zorro.

Don't compare yourself to other people, nerves can increase tremor and some people just take more time to get better at manual tasks and/or don't have the same level of baseline dexterity.

At the end of the day though only you know if you will be able to perform certain procedures to an adequate level.

If you are able to do things like tie knots and suture on your own at home comfortably with minimal tremor then nerves are the most likely issue and with increased exposure you will be fine.

What i wouldn't suggest is entering a field because you feel your tremor WON'T disadvantage you and then overlook other areas of the field that you don't particularly enjoy.

 

[bobbyseal]

I had an attending once who was known as San Andreas hands. He is a great surgeon despite the moniker.