For this rotation I had a mid-site and final-site evaluation. This differed from my other rotations because it was the first time I had an in-person evaluation and it was also the first time I had a one on one evaluation. I have previously liked to have my evaluations with my peers because I was able to learn from their patient encounters, but I also enjoyed the individualized meeting because I was able to discuss any concerns I had more openly and we were also able to spend more time discussing my patients and my presenting skills, giving me a more personal learning experience. Another way this was different than previous rotations was because I presented soap notes instead of H&Ps which is standard in the surgery specialty.
During my first meeting I presented a patient with a perianal abscess and another patient who came in with bleeding into her ostomy bag. The second patient was a very interesting case being that she had previously had a left sided hemicolectomy with an ostomy but then came back presenting with a GI bleed. Despite all of the diagnostic tests done the source of the bleed could not be found and the doctors decided to go in and remove the rest of her colon in hopes that the source of bleeding was from there. During my meeting we were able to discuss the different diagnostic tests for localizing a bleed and the risks vs. benefits of blindly going in to remove the colon despite the source not being confirmed. I also presented a journal article about robotic vs. laparoscopic R hemicolectomies. I decided to look this up because the patient’s surgery was done robotically and the use of robots in surgery has been a discussion I heard many surgeons discussing. We discussed the benefit that robots provide, primarily the steadiness of their “hands” and also acknowledged that it lengthens the time of surgery. We mentioned that if a patient can’t handle the length of surgery they may opt to not use the robot, or to use the robot and lower sedation a little bit during designated breaks.
For my second site evaluation I presented a patient who presented with RLQ pain and was found to have a cecal mass on colonoscopy. We discussed the importance of removing the mass despite the pathology report, which is not something I knew before. I thought that if it was benign it could be left in, however I learned that no matter what, because it was causing symptoms it should be removed. The second patient I presented was an 85 year old male who was post-op day 2 after resection of rectal cancer. In this patient write up I wrote in the physical exam section that there were no signs of infection at the incision site and in parentheses I wrote warmth, erythema or exudates. I was taught that I should skip writing the first half (no signs of infections) and instead write exactly what I saw. So, instead I should have written “no warmth, erythema or exudates at the incision sites.” This makes a lot of sense and will help improve my documenting skills.
