Do you have to be top of the class to be a surgeon??

[PCD123]

I was just wondering wether to become a surgeon one would have to be at the top of thier class in med school, by top I don't exclusively mean number 1 but within the top few?

[Spencer Wells]

I was just wondering wether to become a surgeon one would have to be at the top of thier class in med school, by top I don't exclusively mean number 1 but within the top few?

Short answer: no.

[alex MD]

Short answer: no.

Is there a long answer tucked away? Spencer, for certain surgical specialties, would coming at/near the top of the class be important? For example cardiothoracic/neuro compared to general? (Although I realise all surgical specialties are competitive including general)

[Spencer Wells]

You med schools rank helps with getting foundation posts (but not as much as the white space questions). To get on a basic surgical training programme, you need to interview well and demonstrate commitment to the specialty, which can be done by gaining the MRCS in your foundation years, or by carrying out relevant audits and being published in the relevant field. After your 3 years of basic surgery, you apply for subspecialty training. Here, what counts is again interview and enthusiasm and proficiency you've shown for the specialty (be it vascular, colorectal, neuro, cardiothoracic or whatever) and whether you've demonstrated this with audits, publications, teaching etc. Your med school mark doesn't come into it. For starters - you probably won't even be told exactly where you rank in the class.


What do you call a guy who graduates bottom of his class from med school?

Doctor.

[alex MD]

You med schools rank helps with getting foundation posts (but not as much as the white space questions). To get on a basic surgical training programme, you need to interview well and demonstrate commitment to the specialty, which can be done by gaining the MRCS in your foundation years, or by carrying out relevant audits and being published in the relevant field. After your 3 years of basic surgery, you apply for subspecialty training. Here, what counts is again interview and enthusiasm and proficiency you've shown for the specialty (be it vascular, colorectal, neuro, cardiothoracic or whatever) and whether you've demonstrated this with audits, publications, teaching etc. Your med school mark doesn't come into it. For starters - you probably won't even be told exactly where you rank in the class.


What do you call a guy who graduates bottom of his class from med school?

Doctor.

Thanks Spencer, it's good to hear some clear info when there's so much incorrect information being bandied around That's good to know that med school rank isn't going to really affect your career. While I'm not planning to p*** around in med school, neither do I want to become a one-dimensional social retard just to get a surgical job.

Do the interviews consist of consultants asking about clinical scenarios relating to that specialty? How common is it for a medical student to be published? This is going to be really nosy, but are you planning on a surgical career? Sorry for all the questions, but it's nice to have a chance to get some clarity, even though this won't affect me for a few years

[Spencer Wells]

I am now and have always been a surgeon at heart.

I've not had an interview for a surgical training post, so I can't speak from experience, but from what I've heard the interviews are meant to explore you reasons for wanting to become a surgeon, and are a chance to explain in greater detail than an application form exactly what you have done to show your commitment to the specialty. They want to know that you can reflect well and identify your own learning needs, and may for example ask you about a mistake that you made, what you did about it, and how you have changed your behaviour in order to prevent such a mistake happening again.

It is not common for a med student to be published, but many still manage it, and is probably easiest through intercalated BSc work. All foundation doctors have to do an audit cycle, and these can sometimes be published too. Declare your interest early, and approach a friendly member of faculty about getting involved in some research - even if it's just dogsbody work for a bit before you get to make any real contribution that you can put your name to.

[alex MD]

I am now and have always been a surgeon at heart.

I've not had an interview for a surgical training post, so I can't speak from experience, but from what I've heard the interviews are meant to explore you reasons for wanting to become a surgeon, and are a chance to explain in greater detail than an application form exactly what you have done to show your commitment to the specialty. They want to know that you can reflect well and identify your own learning needs, and may for example ask you about a mistake that you made, what you did about it, and how you have changed your behaviour in order to prevent such a mistake happening again.

It is not common for a med student to be published, but many still manage it, and is probably easiest through intercalated BSc work. All foundation doctors have to do an audit cycle, and these can sometimes be published too. Declare your interest early, and approach a friendly member of faculty about getting involved in some research - even if it's just dogsbody work for a bit before you get to make any real contribution that you can put your name to.

I loved my surgical work experience so I think it's going to take something special for me to change (but then there's still 6 years to do ). The med school I'm going to has a large research component that leads to a BMedSci; would it be possible to potentially be published from this? If you intercalate, you do a masters but I'm not really sure about opportunities for published research with a master's degree. Anyways, I have to say that research looks fearsomely difficult.

Early on in medical school, I'm planning on poking my nose in relevant places and getting my face known, if anything if show's your interest and willing to do something outside of the curriculum to help your potential prospects

Anyway, thanks for answering my questions Best of luck for finals and your surgical career (any particular specialty?)

[Spencer Wells]

A BMedSci is certainly a good chance to be introduced to the basics of research. Masters can either be taught or research based - in a research masters you'd be expected to get published at the end, unless you're very unlucky.

The most fun surgical firm I've done has been vascular, but much of the vascular surgeon's bread and butter work is now going to the interventional radiologist, so there may well be fewer required in future. I enjoyed plastic surgery when I did it, but it's bloody difficult to get in to. Cardiothoracics, which I'm doing at the moment, is real danger stuff, love it, but there are only 6 jobs in the country each year, so it's highly unlikely that I'd get one of them - and many of the current registrars found themselves unable to get a consultant position and subsequently were forced to retrain as GPs (after giving 9 years to CT surg!). Neurology is my favourite medical specialty, and with a neurophysiology degree under my belt neurosurgery could be something to look into, but again, there are only 9 jobs. It ain't easy.

[alex MD]

A BMedSci is certainly a good chance to be introduced to the basics of research. Masters can either be taught or research based - in a research masters you'd be expected to get published at the end, unless you're very unlucky.

The most fun surgical firm I've done has been vascular, but much of the vascular surgeon's bread and butter work is now going to the interventional radiologist, so there may well be fewer required in future. I enjoyed plastic surgery when I did it, but it's bloody difficult to get in to. Cardiothoracics, which I'm doing at the moment, is real danger stuff, love it, but there are only 6 jobs in the country each year, so it's highly unlikely that I'd get one of them - and many of the current registrars found themselves unable to get a consultant position and subsequently were forced to retrain as GPs (after giving 9 years to CT surg!). Neurology is my favourite medical specialty, and with a neurophysiology degree under my belt neurosurgery could be something to look into, but again, there are only 9 jobs. It ain't easy.

Oh well, hopefully that introduction to research could be a stepping stone. It seems surgery is undergoing some pretty major changes, I've heard of potential plastic trainees waiting up to 7 years for a training position. This might sound like a stupid question considering the procedures in CT surgery but is it heart racing stuff (no pun intended )? That would suck to give 9 years to CT only to retrain in a non-surgical specialty. Neurosurgery looks superb, probably that and general is where my current interests lie. But general is becoming so sub-specialised that it's a case of finding a sub-speciality that grabs and holds your interest. Although ABB at A-level makes neurosurgery look unlikely..

[geezer6]

You don't need to be top of the class to become a surgeon. Quite the opposite actually. I know what you're saying, but it's almost an insinuation that surgeons are the most intelligent in the medical profession, which would make some chuckle. How can you be clever when your job involves cutting holes in things every day and not having many friends??

I think you need to forget that "top of the class" bullshit and realise that if you want to become a surgeon (any type), you've got to graft your balls off and neglect yourself for the rest of your life - a) because there will never be enough of you to go around and b) because the workload is relentless. Oh, and c) because everyone else wants your job. Not necessarily because you need to be clever to do it.

When you start being a house officer, you will notice about 5 people in your cohort crack and not be able to deal with the workload and stress, mainly because they're spending 2/3 of their life in work and not having an adequate social life. For whatever reasons, that cohort will differentiate out and decide what they want to do - predominantly on account of how much of a (kind of) real life that career choice permits them. Surgeons want to become surgeons as pretty much from day one; it is required to become blinkered and consider nothing else.

You made a comment about being a one-dimensional social retard? It's almost par for the course if you want to do surgery. I've not met many surgeons that don't have some sort of significant personality defect. You've got to be completely single minded, focused, driven, and be willing to realise that you will make huge life sacrifices to become a surgeon - even if it means telling your girlfriend you're off to Fife next year because that's where the surgery is. She won't come. When all of your mates are going out after a hard 12 hours in work, you will be opening your MRCS core text to revise for an exam in 4 months' time, while practicing how to open an artery clip left handed at the same time, and practicing hand-ties on a stool as a "break". With your feet. Friends are just this "thing" that "other people" have. After this, you will read a few pages of a surgical journal because "you're expected to".

I came out of medical school roughly approaching the top of the class with a couple of hiccups along the way, which were more valuable to me than any A grade or intercalation or "mature background". I enthusiastically worked a very busy 2a rotation in a very busy London hospital (and decided I wanted to do surgery at that point) and then did a whole year of Surgery in one of the best surgical centres in the country. The workload was ridiculous. 12 hour days were the norm rather than the exception; on-calls pushed this to something similar to old-school hours. We worked out the SHOs were working a 2a and getting paid a 1a, and the SpRs were working a Band 3 and being paid a 1a. When one of the SpRs complained about this, they threatened his career progression. I think the exact quote from a previously quite nice consultant was "if you persist with this, it could have serious implications for your career". When the SpR said, "is that a threat?", he said, "yes."

Whenever you felt like you were making progress and developing in confidence as a Surgical SHO (even one who wanted to do it, and not one on a GPVTS), someone started asking why you hadn't done this that or the other - why you still hadn't took MRCS (erm, I'll just find that £475 under my mattress), why ATLS wasn't on the cards (erm, I'll just find that £675 under my mattress), why you hadn't done any teaching yet, etc. Coming from a medical school that seemed set up entirely to train GPs in communication skills to the detriment of anatomy and surgical teaching exclusively, it was a little bit of a disadvantage.

I hit the end of that surgical rotation broken, and considering quitting the rotation/medicine at some points due to the sheer bullying at points I had to suffer. I found it a surprise when the director of surgery gave a top reference, because I honestly thought he hated me. One particular time when he rang me at 830pm at night just as I was leaving the hospital to tell me to rejig the theatre list and tell 4 patients their operations would be cancelled does spring to mind.

I then moved to Orthopaedics and got bullied and completely humiliated twice as much for four months every morning in front of a projector, 5 consultants, 5 nurses, 7 SHOs and 7 Regs for an hour, which included choice put downs as, "boy (generic reference for any SHO), you're like the Times of India. Far too many words at 17 sections - even on a Thursday" and "Q: boy, you've decided that this shoulder replacement is a good one. Why is this? A: Because you put it in boss. Retort: See, the twit is learning. Next SHO to the front please..." I considered General Surgery "a good rotation" at this point.

When December came of that year, people were asking what deaneries you wanted to apply to, and how well your logbook was coming on. I never felt particularly well prepared for this, thinking my only career guide had no faith in me until about a week earlier and told me to "piss off, I'm busy" when I asked him for an MMC-style "induction meeting and career guidance". I had no careers advice or induction prior to working that year - it was literally about daily survival and getting all of the jobs done, picking up the sickies and not killing anyone. Unsurprisingly, when the applications for ST came up, I felt woefully underprepared and inadequate for interview, and thus decided it wouldn't be a good idea to apply. I went for a Surgical MSc which was funded entirely by myself doing locum work for the whole year when I should really be studying (fees £6k - ouch), and applied for GP as a lifeboat. My intention was to do MRCS in that year as well.

I got the MSc after being completely lambasted for a "light CV and lack of interest in surgical journals" - to which I replied I was a house officer plus 5 months. I turned up to GP interviews having not revised at all, cockily sat the tests and did the interviews and smashed it. Then I spent about two whole months trying to work out what I really wanted to do.

I still haven't completely decided, although I have, in fact.

Unfortunately, the MSc was completely financially non-viable with a 16k car still to pay off, and after sending various letters to and from the University, they offered me a defer and begged me to take the job this year with the promise of lucrative work in the private sector which has yet to materialise, and probably never will. Meanwhile, a 3 year GP StR rotation in Surrey landed in my e-mails. Apparently my lack of regard for the MTAS style applications for GP seemed to take the stress off so significantly that I performed well on zero revision.

I accepted the Surrey GP rotation in a very very nice area, citing career and locational security in a financial depression versus repeat applications every 12 months and nil guarantee of career progression, excellent pay for less work, better organisation and support as a trainee, and the opportunity to drive my own career and choose what [i]I[i/] wanted to do, and less stress as the major reasons. While at the same time, Surgery decide to opt out of the EWTD as faculties around the country fall apart while trying to implement a "compliant" rota, meaning half the workforce are at home, asleep at any one time. The director of surgery recently abused the most senior SHO for wanting to take a week off, telling her she was "unreliable as you're always off, and I would rather employ a nurse practitioner than you".

Taking GP does feel like I'm making a right choice in review of a particularly shitty year, but I wasn't prepared to commit to a career which had such scant regard for its juniors, irrespective of my abilities. I still wake up every morning asking myself if I have made the right decision, and cursing myself for my lack of ambition, but I'm sure, somehow, that will manifest itself in some other way that won't be to my neglect along the way. Plus, I might actually get a girlfriend after two years of being a complete hermit. "I'm on nights next week and I have a resus course the week after" isn't the best chat-up line when a girl asks when they can see you next.

I think the net point in all of this, is that Surgery, from my perspective, isn't all that peachy. If one of the major things in life for you is being able to tell someone at a dinner party that you're a surgeon and then bore them about surgical chat for an hour because you can't talk about anything else (or in fact going round hoping people ask if you are because no-one really wants to talk to you because you're odd), then yeah, do surgery. If you like the practical aspects of surgery, the basic and clear cut of diagnosis and case management, and the "challenge" that surgery presents to you as an individual and a career, then yeah, definitely go for it.

But you do have to put your balls on someone else's mantlepiece for your entire life. It was a commitment I couldn't bring myself to make, but in the long term, I will be much much happier, on better pay, with a life of my own too. And before anyone says, I will be just as intelligent too.