What to do on Transplant Sub-i?

[illinichief89]

Hello,
I am doing a Sub-i in transplant surgery in August... but I don't really know what I am doing in surgery still. I never rotated through a transplant service during my 3rd year. Does anyone have any experience doing a Transplant Sub-i that could share some tips with me on what I should do on the rotation(of course work hard)? Also, on a more general note, what is expected of a Sub-i? I still struggle to put together an assessment and plan, as well as presenting patients in a quick manner. I really love surgery, and transplantation has always fascinated me, which is why I chose to do this rotation. I just don't want to look too foolish on this rotation! Please help.

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[doyouhaveaflag]

Transplant surgery was my original plan going into med school, although I have since changed my mind. I did a rotation on it last year though.

One thing that struck me (and part of why I changed my mind on specialty) was that your day-to-day is actually a lot of internal medicine. The patients (at my center anyway) are in the hospital primarily because of medical complications of their transplants. Most of them seemed to be infections, but there were some rejections as well. So, it may be good to study up on the immunology of the different types of rejections. Definitely know your immunosuppression drugs. Brush up on your causes and management of UTIs.

As for expectations, it will depend entirely on your team. I came in before the intern to print the patient lists and note the Is & Os then I pre rounded on my patients. Once the chief resident came in, I would present on resident rounds. Then we would table round with the whole team: attending, pharmacist, social worker, etc. I was only expected to take call once a week, but I just told the resident to call me anytime they got a donor and I would come in for the transplant because you can't predict when the deceased donor transplants will happen. This was when I was an M3 though - not sure how it would differ for a sub-I.

How succinct your presentation will be will also depend on the preference of your attending. I had two different attendings on during my rotation and they wanted very different things. I would just ask your resident at the beginning what info they want and try to mimic how they do it. If people start walking into the room before you're finished, you've gone on too long.

 

[TypeADissection]

Not much more I can say. Everything written above is pretty spot on. I loved transplant surgery. To the point that I thought about doing it as a career many many months after I left the rotation. But it's very medicine. Maybe the most medicine-ish of the surgery specialties. But you have to live the life and see if it's something that jives with you. I got excited hearing about a potential liver and kidney that was going to be available around 0700 after pre-rounds. This translates to you going out to get it around 1700 after all the testing and matching stuff that goes on behind the scenes. So now you're flying out at 1700, landing at who knows when, and guaranteed you're going to be sitting in the physician's lounge just waiting because there are always delays. So let's say you open and procure organs at 2300, then it's back on the plane, back to home base and the fellow is going to say, "You wanna stay for the implant?" You're not going to say no. So at 0400 you start putting the liver in until whenever it ends. Rinse and repeat and there in a small microcosm is the busy, terrible, awesome, ridiculous life of a transplant surgeon. Have fun though. These dudes/dudettes operate like the pimps that they are. Cheers.