醫學六陳盈伃
April
20, 2014
Reflection on Harvard Medical School
Exchange Clerkship Program
This past winter, I was fortunate
to be able to participate in an exchange clerkship program at Massachusetts
General Hospital’s Department of Plastic and Reconstructive Surgery. Although I
was nervous at first about the expectations that would come from being at one
of the top ranked hospitals in the United States, I was also excited about what
I would be able to see and learn while there.
Over the course of four weeks, I
was able to see firsthand the wide spectrum
that the plastic surgery department covers. Ranging from craniofacial and
breast reconstruction to hand and wrist microsurgery, aesthetic surgeries and
procedures, various wound closures, and congenital malformations, plastics is
one of few departments that cover such an extensive area of the body and
subsequently, an even wider spectrum of diseases and conditions. The entire plastics team (including the attendings, residents,
nurse practitioners, scrub technicians, and nurses) was very welcoming and with
their eagerness to teach, they were instrumental in helping me develop my clinical
decision making skills.
At MGH, our day started at
6 AM for rounds with the team of residents and nurse practitioner on duty. During
this time, we checked up on all our patients, who were dispersed throughout
various wings of the hospital, and changed dressings as needed. After rounds,
it was time to head into the OR, with typically 5-10 surgeries scheduled daily
(this depended on which attending was in the OR that day). Nonetheless, with
this caseload, there was a variety of things to see and learn, ranging from
breast implant reconstruction after a bilateral mastectomy to a belt lipectomy,
ventral hernia repair using tissue expanders, and even cutting-edge migraine
release. In fact, during my four weeks, I had the chance to see all the steps
of the reconstruction ladder first hand (starting with dressings and primary
closure, to delayed closure, split thickness graft, full thickness graft,
tissue expansion, random pattern flap, pedicle flap, and finally, free flap).
On Thursdays, the
residents all participated in the cosmetic clinic. One resident would be
assigned to each individual consultation, in which they would go see a particular
patient and perform a thorough evaluation for whatever it is that the patient
would like done (ex. breast augmentation, liposuction, chin implant, etc.).
Then, the resident would present the case to the entire group and we would
discuss the case together and confer about the feasibility of what the patient
wants and what surgeries/procedures can be used to attain it without
endangering the patient. Once the entire group had a good understanding of the
case, we would all go see the patient together and perform a final evaluation.
At the end, the chief resident would sit down with the patient individually to
discuss possible operation plans and arrange another pre-operative visit if
they choose to proceed. I really enjoyed “cosmo clinic” because I got to see
how a complete consultation is carried out, starting with asking what the
patient wants done, why they want it done, and figuring out how we can go about
giving the patient what he or she wants in a relatively safe manner.
Overall, this was a great learning
experience for me. I was not only able to work with outstanding physicians and
learn new medical knowledge and clinical skills but also able to appreciate the
importance of working as a team, communicating with each other, having a good
support system in place so we can provide the best possible care for our
patients.
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