Dr. Andrea Merrill Shares The Ins and Outs of General Surgery

by Dr Andrea Merrill

Dr. Andrea Merrill is a General Surgery Resident at the Massachusetts General Hospital. She has completed 3 years of residency, 1 year of breast cancer research and will complete a 1-year editorial fellowship at the NEJM before finishing her last 2 years of surgical residency. She received her BA in Spanish and Community Health from Tufts University in 2006 and her MD from Tufts University School of Medicine in 2011. She plans to apply for a surgical oncology fellowship.


Q. Why did you choose General Surgery?
A: I started medical school intent on pursuing orthopedic surgery. In fact, orthopedic surgery is what had drawn me to medicine in the first place. I was always injuring myself growing up through various sports, and with each injury I would turn to books or the Internet to learn more. Soon I had amassed a small encyclopedia of knowledge based on my own experiences and decided to pursue a career focusing on sports injuries. I continued on this line of thinking through most of medical school and conducted orthopedic surgery research during my summers. However, I found that I really loved all of my courses in medical school and wanted a specialty that involved more medicine and pathophysiology. I still think orthopedics is a great field, but you limit yourself and often “trade” in the knowledge that you learned in medical school for a whole new set of knowledge “fractures types, grades, etc.”. I wasn’t ready to enter such a narrow field and felt that general surgery combined my love for medicine and surgery. To be a truly great general surgeon, you really have to look at the patient as a whole and practice medicine in addition to surgery. I am extremely happy and fulfilled in this field and have not regretted my decision once.


Q. Was medical school pass/fail or grades? What were classes like?
My medical school had grades for all course when I was there. Most exams were multiple choice and we often had practice tests to study from which helped. Make sure to use all available resources to study and talk to people in classes ahead of you to see what they did. Since I’ve graduated, the curriculum has changed quite a bit- it’s much more condensed and I’m pretty sure the basic science courses are pass/fail now. While it is important to learn as much as you can from the basic science and pathophysiology courses, the most important “classes” for getting into residency are your clerkship rotations (i.e. medicine, surgery, pediatrics, etc.). This is where you’ll be graded based on your clinical knowledge, written and oral presentations, teamwork and professionalism. These are usually graded on a pass/fail/honors/high honors scale. Most residency programs focus on these grades and evaluations from the clerkship director. A bad basic science course grade can be offset by stellar reviews on your core clerkships. There is also a multiple-choice test at the end of each rotation that makes up a small proportion of your grade.


Q. How hard was it to match?
This is a hard question to answer because it depends on the specialty you choose and the caliber of program you desire. Obviously, the top programs are competitive in every specialty. The hardest specialties are orthopedics, urology, ophthalmology, dermatology, ENT, plastic surgery (in no particular order) mostly due to lifestyle. Many people who plan on going into these specialties pursue research either during medical school or during an extra year.

For me, what I think was key in helping me get into the program I wanted was doing an away rotation (or sub-internship) at the program. However, I say this with caution because some people come across better on paper than in person. During an away rotation, you will spend an entire month at the program so any weakness you have will come out. That said, it is an excellent opportunity to showcase your strengths and determination and to potentially meet with the program director. Oftentimes this can help set you apart from the rest of the “pack” who all probably have similar grades and achievements. Programs want to know that they are choosing someone they like, someone who is honest, and someone they can get along with.


Q. What is a typical day like as a surgical resident?
This depends on your year of training

(and program). As an intern, you usually get to the hospital by 5:30-6AM and get sign-out from the night float intern (all programs now have a night float system in place due to work hour restrictions). You then round on your service with a senior resident who tells you the plan for each patient that day. After quickly putting in orders, you then go to assigned cases in the OR (for interns this is usually melanomas, breast cases and thyroid cases). As an intern, I was generally in the OR most of the day but we are very lucky to have great NPs and PAs who round with us and help take care of our patients while we are in the OR. After the OR, we will generally round again on the service and then sign-out to the night float intern who arrives at 6PM. You will usually stay a little later to update your patient list with daily events, take care of paperwork such as discharge summaries, and ensure that all patients are ordered for morning labs and tests as needed. As you progress in the program, you take on a more senior role on each service with more autonomy and assignments to more complex cases.


Q. How do you balance work with other aspects of your life? Do you have a family/kids? How much of a life do you have outside of surgery? Do you have any interests outside of medicine?
Work/life balance is tricky in all specialties of medicine, especially surgery. With the new hour restrictions, this is easier nowadays but still challenging. It is easy to get caught up with work or patient care and stay late or get behind in paperwork, especially when you first start out. As you progress in residency, you’ll find ways to be more efficient which translates into more time outside of the hospital. However, as you gain more responsibilities and perform more complex cases, you do become more invested in your patient’s care, which can make it hard to leave, even when you know your patient is in good hands with the night team.

While I am not married, nor do I have kids, plenty of my co-residents do. Some of them have spouses in medicine but many do not and I know they are always looking for ways to spend more time with their families. It is hard but not impossible. You have to accept that you may miss important events due to our schedule. And it does not necessarily get better as you become an attending- they don’t have any rules governing the number of hours they can work! Certain specialties are more predictable with few emergent cases (such as surgical oncology, colorectal surgery, endocrine surgery). Cardiac, thoracic, vascular and transplant surgery probably have the hardest and most unpredictable lifestyles.

I do think that I have managed to have somewhat of a good “social life” outside of residency. Mostly this consists of hanging out with friends and going out to dinner. I also try to get to the gym several times a week. I’ve managed to keep up my hobby of cooking and baking and even started a baking blog during residency. Some co-residents have run marathons and ironmans. Others are avid hikers and fishermen. You may have to sacrifice some sleep to pursue your outside life, but as surgeons we are used to that!


Q. What do you wish you had known before starting med school and/or residency?
I think the best advice I can give is to try to make the most of the time you have before medical school and residency. While it is important to establish an interest in medicine via research, volunteering, etc., it is also important to experience fields outside of medicine. So if you want to major in Philosophy or English Literature, you should! Medical schools these days are looking for well-rounded students these days. They want students who enjoy what they do and are going to be happy in medicine and I think having interests outside of medicine is important for that. You will have the rest of your life after medical school to devote to medicine, so if there is something you really want to do now, you should do it! It may at least make for an interesting story for your personal statement.

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