So you want to be a trauma surgeon. You’ve come to the right place. In this episode of
So You Want to Be, let’s talk about what it means to do trauma surgery, the training
process, and some of the lesser known upsides and downsides of being a trauma surgeon.
Dr. Jubbal, MedSchoolInsiders.com.
Welcome to the next installment of our So You Want to Be series, where we highlight
a specific specialty within medicine, and help you decide if it’s a good fit for you.
You can find the entire list on our So You Want to Be playlist. If you want to help us
decide which specialty or healthcare professional to cover next, drop a comment down below with
your request.
If you’d like to see what being a trauma surgeon looks like, check out my second channel,
Kevin Jubbal, M.D., where I do a second series in parallel titled a Day in the Life.
Trauma surgery is a subspecialty of surgery primarily dealing with patients who have undergone
a physical injury, often in an acute setting. Not all trauma requires surgery, and depending
on the specific injury, these patients may also need further treatment from neurologists,
internal medicine doctors, and more. The majority of injuries addressed by trauma surgery include
those of the neck, chest, abdomen, and extremities.
In Europe, trauma surgeons treat most of the musculoskeletal trauma, whereas neurosurgeons
handle injuries to the central nervous system. In the United States and UK, however, skeletal
injuries are primarily handled by orthopedic surgeons, and facial injuries are often treated
by plastic surgeons or maxillofacial surgeons. Neurosurgeons typically manage injuries to
the central nervous system in these countries, too.
Trauma surgeons must be familiar with a variety of general surgical, thoracic, and vascular
procedures. Trauma conditions can be described as blunt or penetrating. Blunt would include
injuries from a motor vehicle crash, falls, ATV rollovers, and assaults. Penetrating injuries
include gunshot wounds, stab wounds, and the like. Additionally, they’re dealing with
high acuity situations, often with little time and incomplete information with a patient
in front of them who is rapidly decompensating.
The more traditional trauma surgical interventions often include procedures such as exploratory
laparotomy, where the abdomen is opened and the abdominal organs examined for injury or
disease. Thoracotomies open up the chest, and tracheostomies are procedures for insertion
of a breathing tube through the throat. Over the past few decades, advances in trauma and
critical care have led to more non-operative, and sometimes minimally invasive treatment
modalities. This is good for patients, as less invasive therapies often have better
outcomes.
To become a trauma surgeon, you’ll complete medical school and then do 5-7 years of general
surgery residency, depending on whether your residency includes a two-year research block.
From there, most trauma surgeons do a 1-2 year fellowship in traumatology, surgical
critical care, or emergency surgery, for a total of 6-9 years of additional training
after medical school.
Pediatric trauma surgery is part of regular peds surgery training. Depending where the
ambulance takes the patient, sometimes it gets managed and triaged acutely at the adult
hospital, but ideally goes straight to the pediatric trauma center.
If you’re interested in more specific types of trauma, there are other specialties to
consider. For example, orthopedic trauma focuses on surgical intervention of traumatic injuries
related to bones. If you want to deal with spine and cranial trauma, neurosurgery would
be your specialty.
General surgery residency is middle of the road in terms of competitiveness, with an
average matriculant Step 1 score of 234, with the national average at 230. As with most
surgical specialties, trauma surgery is male dominated, although not as much as some other
surgical specialties like neurosurgery or orthopedics.
As a surgical specialty, your general surgery residency and trauma surgery fellowship will
be incredibly taxing with long and often unpredictable hours.
Rather than telling you what it’s like to be a trauma surgeon, I’m going to hand it
over to my friend, Dr. David Hindin. Not only does he have an awesome YouTube channel that
you should definitely check out, but he’s also a general surgeon with extensive trauma
experience from his surgical residency at Temple University Hospital in Philadelphia.
Without further ado, here is Dr. Hindin.
We joke around sometimes that trauma surgery is kind of like general surgery on steroids.
All of the regular principles that we have in general surgery are still there. And many
of the procedures and maneuvers are the same, too. In trauma surgery, you might find yourself
removing and reconnecting different portions of the small bowel and colon. You might find
yourself removing a portion of the lung, or repairing a hole in the diaphragm. And you
might find yourself deep in the abdomen exposing the retroperitoneum to repair a vascular injury.
All of these are techniques, and maneuvers, and procedures that we might do in other areas
of general surgery. But the difference in trauma is the urgency and often the speed
at which we have to do this work.
And just as trauma surgeons may have to perform surgery in a much more urgent timeframe, these
surgeons also must make decisions about patient management, and take action, often with limited
information, in the blink of an eye. But more on that in a few minutes.
There’s a lot to love about trauma surgery. It’s a specialty that’s fast-paced and
exciting. And more than any other area in surgery, trauma is an environment where you
can have an immediate and lasting influence on someone’s health, with actions that play
out in seconds to minutes. After all, what could have a larger impact than saving someone’s
life?
Trauma surgery also tends to attract surgeons who like to perform what we’d call “BIG”
operations. Many of these procedures involve making long incisions, creating major exposures
of vascular structures, and performing large-scale repairs of significant injuries throughout
the body.
One of the most common procedures we do in trauma surgery is called an exploratory laparotomy.
In this surgery, a long incision is made from the top of your abdomen just below the ribs,
straight down the midline to below the belly button. Once the abdomen is entered, surgeons
are able to quickly “run the bowel,” meaning that they examine your entire intestines from
end to end. This type of procedure is typically carried out very quickly, so that surgeons
can quickly locate injuries - for instance, from a bullet or a knife wound - and then
determine the next best steps to stabilize the patient, control any bleeding, and repair
the injury.
And at the same time they’re inspecting the intestines, they’re also looking at
solid organs within the abdomen and different zones where your major vascular structures
lie - like your aorta - to see what other injuries may need to be addressed.
Another trauma procedure that’s unfortunately somewhat common in urban areas with a large
amount of crime and violence is called an “ED thoracotomy,” or a “crash thoracotomy.”
This is a procedure that’s typically carried out in a portion of the emergency room called
the trauma bay, and it’s done for patients who come in without a heartbeat after a form
of penetrating trauma. In this procedure - over the course of a few minutes, a large incision
is carried out across the left chest, the heart is released from the pericardium, and
a cross-clamp is placed on the aorta to help reduce the amount of blood loss. Visible injuries
to the heart and lung may also quickly be controlled with a clamp to help achieve hemostasis,
or stop bleeding. At this point, the surgeon performs what’s called open cardiac massage,
which means squeezing the heart between one’s hands to try to restore a heartbeat, like
a kind of internal CPR.
As you can probably tell, even though most specialties within surgery these days require
a surgeon to specialize and commit to operating in one part of the body, a trauma surgeon
could find him or herself removing a portion of the lung, repairing a bleeding cardiac
injury, removing a damaged spleen, and repairing a hole in the intestines, all in the same
day - and maybe on the same patient.
Another thing to love about trauma surgery is the mix of critical care medicine that’s
involved. Most trauma surgeons balance their time operating with helping to manage ICU
patients. This requires a more intellectual side of surgery that can often be a really
nice balance to the more intense operative side of things.
Also, trauma surgery typically runs on a shift-type schedule. This means that while you might
be incredibly busy while you’re at the hospital, once your shift is over, one of your partners
takes over your responsibilities and your time outside the hospital is completely yours.
To contrast, some surgeons within other specialties are on call 24/7 for their patients.
But there’s also a flip-side to all of the excitement. The high intensity, action-packed
moments of trauma surgery can also come with their toll - it can be exhausting and draining,
both physically and emotionally.
Having critically ill, badly injured patients often means that unfortunately there will
be many patients who arrive in your trauma bay that you just can’t save. Having to
break bad news to loved ones of patients on a regular basis is an emotional weight that
can be hard to over-emphasize. This is an incredible burden that trauma surgeons have
to carry.
And - because traumas can occur at any time in the day, trauma surgeons also have to be
available 24 hours a day, too. That means that when you’re on call at the hospital,
there’s no guarantee what your day (or night) will be like. Things can be quiet all morning,
afternoon, and evening, and then trauma patients can suddenly start pouring in, needing multiple
operating rooms to open up to take care of the sudden volume. Shifts like this can be
exhausting for surgeons, and for some people they do take a toll. The unpredictability
can also be a source of stress in itself.
Also by the very nature of what trauma surgeons do it’s one of the areas of surgery where
you’re unlikely to have patients seek you out to be their surgeon. After all, trauma
patients aren’t expecting to be having an emergency! But along those lines, it’s good
to know that most trauma surgeons also have an office practice of general surgery - so
these surgeons often see patients who come to them for elective surgeries like hernia
repair, gallbladder surgery, and other procedures.
At the end of the day, trauma surgery is an incredibly meaningful and rewarding surgical
specialty.
People who should go into trauma surgery are those who thrive within fast paced, high-intensity
environments … people who like making a decision, putting together a plan and executing
it, quickly - and without hesitation. If you’re someone who prefers to mull over every decision,
trauma may not be the field for you.
Trauma surgery is also ideal for people who thrive in working on teams. Everything we
do requires close coordination with our colleagues in surgery, nursing, anesthesia, and more.
And trauma surgery is also ideal for doctors and surgeons who like critical care medicine,
too - surgeons who enjoy running an ICU and managing patients in intensive care.
Finally, trauma surgery is also ideal for people who like to have a shift work-type
schedule in their life - so that when you’re off you’re truly off from the hospital and
free of responsibilities. This type of schedule in trauma makes the specialty really ideal
for people who have other passions in life and wish to balance their surgical career
with other time commitments outside of their surgical practice.logic
Massive thanks to Dr. Hindin for sharing his expertise in general and trauma surgery. He
has a super interesting story as a surgeon and medical technology innovator, so be sure
to check out his channel, David Hindin, M.D . Link below. Which specialty should we cover
next in our So You Want to Be series? Let me know with a comment down below. Thank you
all so much for watching, and I will see you guys in that next one.