Tips to Excel on a Vascular Surgery Sub-I

Written by Raj Patel

Congratulations and get ready to FEEL THE PULSE! The field of vascular surgery is exciting, innovative, and niche. Having the opportunity to rotate on a vascular surgery service at a new institute might be thrilling but can also be frightening. You have worked tirelessly to get to this position and my advice would be to soak in this feeling because it is the beginning of an unforgettable journey. To perform well, follow the three A’s: availability, affability, and ability. Ability may be the most difficult as a medical student but if you are available to your residents/faculty as well as kind to your patients, this will be a golden ticket to receiving that letter of recommendation. 

Be Respectful 

What you give out, you get back in the same form. First and foremost, be respectful to your friends and family back home. Set proper expectations of what you can give them in the coming months. They will continue to love and support you if you give them adequate notice of your schedule. One of the most important people you will encounter is the institution’s program coordinator. They will give you all the tools to be part of the team so please respect that person. In addition, they will be able to help you navigate the hospital system before the start of the rotation so utilize them as a resource for minor details such as parking and scrub access.

Be kind and respectful to all staff. From the floor nurses to the vascular research coordinators, everyone is working towards a common goal and that needs to be appreciated. Furthermore, the individuals that you are rotating alongside will be your future colleagues. Understandably, vascular surgery is a competitive field but if the residents and staff see you all working as a team, that will show a willingness to adapt to difficult situations. Most importantly, be respectful of your patients. Most vascular patients are extremely sick and have multiple comorbidities. Sometimes because of what these patients have been through, it may be difficult to communicate within the in-patient setting. It is imperative to keep in mind that our patients have lives outside of their disease process and the patient should be considered holistically. As a medical student, you get the privilege to interact with your patients for a longer duration. Use this time to be an advocate for them and demonstrate to your team how much you care for your patients. 

How to Prepare for the OR

My biggest tip is to familiarize yourself with the next day’s surgical cases the night prior. Look up the cases and review the imaging with the residents. No one will expect you to know every step of the procedure but knowing why we are performing said procedure and the anatomy are both fair game. The best way to do this is to have a systemic approach. The Houston Methodist DeBakey CV Education YouTube page has a dedicated vascular surgery playlist where you can find almost any vascular surgery procedure. These quick 5–10-minute videos can help you get an overview of what will be done in the OR. 

The most important aspect of preparing for the OR is knowing the anatomy. As a sub-I and even into the future as a surgical resident, the one thing surgeons will expect you to know is the anatomy. “Anatomic Exposures in Vascular Surgery” is an extraordinary book that will help prepare for any open vascular surgery case. In addition, “Atlas of Vascular Surgery and Endovascular Therapy Anatomy and Techniques” helps with a lot of the core principles of vascular surgery and has many chapters dedicated to endovascular equipment and techniques. Another way to understand indications and integrate research into your readings is by using “50 Landmark Papers every vascular and endovascular surgeon should know.” This text will help you understand why certain procedures are done and the evolution of the ever-changing landscape of vascular surgery.  

Final bits of Advice: 

This is your time to evaluate the program at which you are rotating. Whether this new institute will become home or not, it is key to keep in mind the aspects of the rotation that you admire and the parts that you did not. This will prove useful a few months from now when it comes time to make rank lists. You may have fears about the institution and whether you will be “liked” but try to determine whether you will be a good fit and happy at that institute. My advice would be to ensure that the program can allow you to grow not only as a future vascular surgeon but also as an individual. Moreover, do not forget to have fun. You will see disease processes and cases that you have never been exposed to, which can be exhilarating. Take this time to also build relationships with residents and faculty because the field of vascular surgery is small, and you will meet them again. Lastly, do not forget to FEEL THE PULSE!

Additional Resources: 

• Podcasts

  • Audible bleeding

    • THE vascular surgery podcast. Put on by the Society of Vascular Surgery. This podcast has amazing episodes for everything ranging from talking about key papers in the field to information for med students.

    • Holding Pressure series: they have multiple podcasts about specific vascular surgery-related topics that cover everything from history to the steps of a particular procedure.

  • Behind the Knife

    • A podcast encompassing all of surgery with many vascular surgery episodes. All the episodes related to oral boards for trainees are good to get questions right during rotations. They have good videos on their website about how to suture.

• Manuals/Quick Guides

  • GORE Combat Manual

    • This is a concise PDF document that has a lot of vascular information ranging from how to do a physical exam to the description of most vascular procedures. Highly recommended by most residents and is a must-read before starting a vascular rotation.

  • Handbook of Patient Care in Vascular Diseases

    • Basically, the pocketbook for vascular surgery. I highly advise keeping on hand to read between cases when “bird-dogging” or during downtime on clinic days. Multiple residents and physicians were curious about what I was reading and where I got the manual. It is extremely compact and easily portable.