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Thoracic
Foregut Info:
If you're going into surgery,
you will have to take this rotation as a 4th year student.
Dr. DeMeester won't write his chairman's letter for you unless
you spend time getting to know him on his service. Do not
fear, we will tell you what to expect.
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| The
Who |
There are 4 attendings on the service, including
Dr. Tom DeMeester (chairman) and Dr. Jeffrey Hagen (Program
Director). In case you didn't realize, that means you don't
want to screw up in front of these big wigs. The other attendings
are Dr. Steve DeMeester and Dr. John Lipham:
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| Tom DeMeester,
Chairman |
Jeff Hagen, Program
Director |
Steve DeMeester |
John Lipham |
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| Signing
Up |
Sign
up early in your third year for this rotation, as there is limited
space, and spots go quickly. Even if you are not sure if you
are sold on surgery, sign up, and you can always cancel later.
Here
is all the information you need to sign up. |
| Preparation |
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Before you start,
there are a few things you may want to do. Dr DeMeester
has a chapter in Greenfield's Surgery about the esophagus.
In it, he explains a lot about the surgical anatomy, embryology,
and common mechanisms to test it's function.
If you want to shine, we highly recommend you read his
chapter before starting the rotation. Anything else you
need to know, you can get from the fellows on the service
or read articles or up to date. |
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| Students |
There are usually 4-5 medical students on service at any
one time, and each is trying to maximize face time with Dr.
DeMeester and Dr. Hagen. This is made more difficult by the
fact that both travel frequently, and you will have limited
opportunities to scrub in.
We recommend you create a scrub schedule early, and share
the time with your fellow students. It doesn't happen often,
but occasionally someone in your class will try and steal
the show from you. This is not cool. The way to prevent it
is to plan a fair schedule early and stick to it.
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| In
the OR |
With perhaps the exception of Dr. Lipham, while you are in
the OR, you won't be doing much except retracting (and occasionally
getting pimped). There are two foregut fellows on service,
and at the beginning of the year, even they do a lot of watching
(after all, patients come from all over the world for Dr.
DeMeester to operate on them).
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It is not unlikely that you
may get yelled at or sternly warned for making a small
mistake. If Dr. D or Dr. Hagen does this to you, do not
fear - they don't hold it against you becuase you may
not know any better. Just appoligize, move on, and never
do the same thing again. |
It is a good idea to not anticipate too much, and do exactly
as you are told. Retracting can be difficult at times, but
it is also one of the most important things that can be done
to provide the surgeon with better exposure.
All this isn't as bad as it seems, and the OR can actually
be kinda fun. Here are a few tips about each of the attendings:
Dr. Tom DeMeester is a world class surgeon and likes
to make conversation with you in the OR - so be sure you have
an answer for why you want to go into surgery.
Dr. Hagen is a fantastic surgeon and does like to
teach a lot during some of his easier surgeries. He will also
let you close a lot of times.
Dr. Lipham may let you do a very small part of the
procedure and is an excellent teacher of the fellows in the
OR. He was one of the foregut fellows several years ago, so
he knows what it's like to be in training in this environment.
Dr. Steve DeMeester also likes to teach, and is often
rather hillarious in the OR. He is also very tall, so make
sure you ask for a step in the OR!
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| The
Fellows |
Each year, there are a new group of fellows, and you will
interact with at least two of them while at University Hospital.
They should help you by letting you know how to present your
patients to each attending. With their help, you can be a
superstar and shine!
They will also write a short evaluation of you for your letter
writing meeting with Dr. DeMeester. You can make yourself
look good to them by working hard during your 4 weeks.
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| Typical
Day |
A typical day (Monday - Friday) goes as follows:
4:45-5am - arrive at hospital, 7th floor ICU. Print
out progress note forms for your patient notes
| 5-6am -
pre-round on your 4-5 patients. It is important to get
the data, fill out the forms, and update "the list"
- a sheet to be given to the fellows with lab data, etc.
from each of your patients overnight. |
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| 6-7:30am
- morning rounds with the fellows. Here you will practice
your presentation which you will give to the attendings
in the afternoon - listen to what the fellows have to
say! |
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And make sure you know all the relevant laboratory data (especially
daily weights, bilirubin, temperature curve, and white counts
- as well as what they were yesterday).
7:30am - grab a quick bite if you have time. run the
list in the cafe.
7:30 - 8:00am - go to the OR for the start of the
first surgery (if you are scrubbing in with one of the attendings).
Remember to split up time with Dr. D and Dr. Hagen.
8:00am - 4:00pm - OR time. If you're not in the OR,
you will be rounding on the floor / ICU with the 2nd year
and ICU team or doing work on the floor with the intern.
4:00 - 9:00pm - At some point during these hours,
the 4 attendings will come by for afternoon rounds. You never
know exactly when they want to go, so you have to be ready
at a moments notice. This involves running to the chart to
get any updated info, and pulling x-rays from the file room
(if needed). You will give the same presentation you gave
to the fellows in the morning. Be confident, know your lab
data, and you will be fine. Pimping is usually kept to a minimum
during this time, and is often directed at the more senior
members of the team (and if not, they often step in to protect
you).
After the last attending has rounded, you get to go home!
(unless you are on call, which will usually be about once
a week)
On Saturday, you will come in for morning rounds with all
4 attendings at the same time, and are usually done by 2 or
3 in the afternoon.
You get Sundays off. =)
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| The
DeMeester Letter |
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The whole purpose of doing foregut is to get a letter
of recommendation from Dr. DeMeester.
This "chairman's letter" is often a requirement
for many programs, especially the better known ones.
You have an advantage at USC in that you actually get
to work with and know our chairman (and on top of that
he writes good letters).
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At many other schools, the chairman never gets to know the students,
and that often shows in their required letter. Make sure when
you scrub in with Dr. DeMeester that you write your name on
the board in the OR, so he can call you by name.
| Also be sure to
have an answer to the question, "Why do you want
to go into surgery?" Dr. D likes to ask you this,
and your answer should be succinct but relevant to you. |
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Good luck, work hard, know your lab data on his patients, and
he will write you a fantastic letter. You will be suprised at
just how many interviews you get asked questions about how you
know Dr. DeMeester, since he is one of the pioneers of esophageal
surgery, and is known world-wide. |
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