Alejandro Lopez, MS3, UCSF School of Medicine
When I walked into the operating room on the first day of my surgery rotation, my hands shook, and my thoughts raced. I had the wherewithal to write my name on the dry-erase board near the door, and just as I was struggling to remember my glove size, the second-year resident strolled into the room. After a moment staring at her phone, the resident turned to me and said something that likely changed the course of my life: “Do you know what you’re expected to do in the OR as a medical student?”
I could have hugged her out of sheer relief.
Eight months earlier, I walked into a similar OR on my first clinical rotation of medical school. I was woefully overconfident and, in my rush to get to the action, dropped my gown when it was handed to me. The scrub tech scowled at me and walked back to her mayo stand, refusing to gown me again. As the days passed, I slowly learned the rhythms and skills needed in operative settings. However, residents began to disclose to me that I was not doing some of the basic things that demonstrate an interest in and aptitude for surgery. Only when I asked about these markers of interest did someone walk me through all the tasks that “motivated” and “successful” students should perform on surgical rotations. I was less than a month into my third year, and I had already internalized the idea that becoming a surgeon required insider knowledge.
My mind was flooded with these memories when the second-year urology resident so kindly reminded me of the norms of the OR. It wasn’t that I was unfamiliar with transferring patients, getting warm blankets, retracting, suturing, and the litany of other tasks medical students are asked to perform. Rather, I was moved by the warm and welcoming nature that this kind of teaching showed. Instead of an invader, I felt like someone who belonged in this oddly sterile environment and empowered to excel. Most importantly, however, this resident had given me a window into the hidden curriculum of surgery, a rarely discussed realm of knowledge regarding what surgeons expect of their medical students.
That evening, after holding open a large abdominal incision for eight hours, I arrived at the campus library bone-tired. As I looked for somewhere to rest my weary arms, I noticed a friend walk through the double doors behind me. It was immediately clear that something was off, and when I asked him how his day was, his face grew dark. “Why is surgery terrible?” he sighed as we scanned for open rooms. When we finally found a place to sit, he recounted how he had been told by his residents that, for a student who was interested in surgery, he was not doing the things they expected to see. When I asked if anyone had ever told him what these things were, he said they hadn’t. As we discussed how to bird-dog on OR and when to ask for suture scissors during a case, I realized his tale was hauntingly familiar.
In that moment, I felt the abstract weight of inequity distill into clear reality. My friend and I are Latinx and the first in our families to go into medicine. The system had nearly robbed us both of a desire to pursue surgery because we did not have access to basic but unspoken norms of the surgical field. While I love and appreciate those people, like that wonderful urology resident, who took the time to make these opaque expectations clear, it should not have been her job to do so. Just as it should not have been my job to support and guide my housemate through this same hidden curriculum. Our success should not be based on having the luck of finding someone who is willing to provide you this information, much less an already exhausted resident. What if you never find that resident? How many medical students have been dissuaded from surgical careers because no one outlined how to make these early surgical experiences work in their favor? Thus, my friend and I began to scheme.
We went back and forth: We’ll write something; we’ll go to the deans and propose making these expectations a part of the curriculum; we’ll rally peers who have had similar experiences. Instead, we both realized we needed to study, learn what a running horizontal mattress stitch is, and somehow sleep before 5 am rounds that next morning. As so often happens, the demands of medicine melt our grander plans. What has come to fruition, however, is that I will never forget the shame and embarrassment I was made to feel when I first entered the OR. I will carry that feeling into every interaction I have with a learner for the rest of my life and follow the example of a certain urology R2 instead. I invite you, as well, to choose care and welcome instead of shame and terror when working with those who are junior to you. Becoming a surgeon should test many aspects of character, but I propose that it should not test whether you have the privilege of inheriting knowledge that unveils expectations that remain hidden from the rest of us.
About the Author: My name is Alejandro Lopez (he/him), a Mexican-American who calls the San Francisco Bay Area home. My medical interests are wide-ranging and include andrology, genitourinary reconstruction, healthcare utilization disparities, and medical/surgical education. Outside of school I love to write fiction, go backpacking, play ultimate frisbee, and daydream about my next tattoo.
About the Work: Medical students must learn and adhere to an opaque set of expectations and standards to be seen as interested and exceptional in surgical rotations. This piece explores how students from marginalized backgrounds are often traumatized and dissuaded from considering surgery because they lack the cultural capital or inherited understanding of these norms that many of their peers receive.
Comments