As part of the Physician Assistant program at McMaster University, students are expected to complete three Longitudinal Placements (LP). Students are responsible for setting these placements on their own. LPs are clinical observerships organized by the student in the domain of his/her choice to gain relevant clinical knowledge in that are of medicine.
- Area of Longitudinal Placement: Plastic Surgery
1. What LP did you do?
I did my LP in Plastic Surgery at McMaster University Medical Centre.
2. How did you go about contacting and arranging the LP?
I met a Plastic Surgery resident who helped me set up an LP with a plastic surgeon. The process of setting this LP up was really difficult because there’s a lot of pre-placement work to be done: OR security access, OR orientation, Scrub Session, etc.
3. What were the main things you learned from the LP?
1) Before the days of my placement, I go find the surgeon’s secretary and ask for what type of surgeries he will be performing so that I can read up on them beforehand. It definitely pays to be prepared. Surgical procedures are usually reserved for last resort so when reading about the cases, I focused on why this patient is going in for this surgery/procedure and what indications did the patient have that surgery was suggested for treatment.
2) I learned the proper names of tools and how to use them (YES THEY HAVE NAMES! …like “Curved Iris”. There’s quite a few). I had the opportunity to assist the resident as well. He showed me how to cut sutures at an angle to avoid the knot and different types of sutures/patterns. The surgeon also took a bit of his time to explain local anesthesia to me.
4. What did you wish you knew beforehand to help you in your LP?
Operating Room Etiquette! I had to complete an OR Orientation and Scrub session before my first placement so I really only know how to properly scrub in. I wish I knew that it’s OR etiquette to get my own gloves, to help get the bed when the patient is ready to leave OR, etc.
I also wish I practiced putting on sterile gloves in the absence of a scrub nurse and sterile gown. It’s a challenge not to touch the unsterile parts! The surgeon told me to take my time and do it right.The nurse in the procedure room was really nice and walked me through the whole thing. TIP: Make sure the Avagard (scrub) on your hands is DRY before putting gloves on, or else your hands are NOT going to go in the glove.
HOW TO DO IT PROPERLY!
5. How has this experience helped you clinically, in class and/or in career decision-making?
Plastic surgery is NOT limited to cosmetic procedures! There’s a wide variety of cases that goes to plastics. Skin, nerves, fixing anatomical or traumatic physical abnormalities, everything under the sun! I definitely got to see the surgical side of treatment.
6. Share your most memorable experience from the LP!
EVERYTHING? This was essentially my first OR exposure so everything I saw was very memorable!
Burn patients: When kids start to walk, their parents can’t always keep an eye on them. There were two kids I saw whom have burn wounds on their hands. I observed the nurse as she debrided the dead skin to allow new skin to grow from bottom up. We used silver nitrate (for its antimicrobial activity) to dress the wound.
Mastectomy for gynecomastia: We had a patient with unilateral gynecomastia. The resident performed essentially a mastectomy. The incision was made under the areola so that when the scar heals, it’s not that noticeable.White tissue is the breast tissue,yellow tissue is the adipose tissue. In a mastectomy, we take out the breast tissue and keep the adipose tissue in. The breast tissue is then sent for pathology to see if there were any chance of malignant cells (yes, men can have breast cancer too!). Suture patterns are important! Some will heal cosmetically better than others. After the surgery, the resident then explained to me if an implant were to occur, it would be placed UNDER the pectoralis major (more support for the implant).
Surgery for polydactyly and syndactyly: People can live a normal life with an extra toe so this procedure is for cosmetic purposes. The 2 year old patient had an extra toe on the lateral side of both feet (with bones!). It was cool to assist the surgeon and his resident do the procedure eg. skin graft, sutures, etc.
Basal Cell Carcinoma removal: Usually the dermatologist can remove these themselves if it’s small enough but if it’s close to facial structures or very big, they patient gets referred to a plastic surgeon. The patient I saw had a BCC on his right temple, really close to his facial nerve. If not done properly, the patient may lose ability to raise their eyebrows. The surgeon made an elliptical incision. You can search up margins on removing skin cancers (eg. you have to remove extra skin surrounding the cancer to make sure you got all the bad cells).
The surgeon allowed me to scrub in so I had a lot of hands-on experience.The OR skills I learned are all transferable. I really enjoyed my experience in plastics!