excelling on away rotation

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darkmansaad

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What up guys, I have some sub-i's in ortho planned and was wondering how to excel in them without being a typical suckup. Im a pretty hard worker so im not averse to anything just wanted to know if anyone had any pointers, books to read up on, etc. Thanks a lot y'all, congrats to those that just matched and good luck to those matching next month!

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Memorize Koval's Handbook of Fractures, Netter's Orthopedic Anatomy, and Hoppenfeld's Physical Exam of the Spine and Ext.

That's what I did, and it worked.
 
- Always be early for rounds, meetings, conferences with a good attitude.
- Always offer to round, get numbers, write notes
- Take the initiative. If you round with the team, grab the chart and write a note, start filling in post-op orders or procedure notes, filling out scripts.
- Don't just sit there watching your residents or asking..."how can i help". Always find a way to be busy, reading a book, doing scut, etc.
- On rounds, have all of the supplies ready for dressing changes...and if you pre-round, have the dressings off so that your resident can look at the incision and they you can put the dressing back on.
- Meet as many people as you can, even if you're an introvert, talk with as many residents and attendings that you can.
- Know your place, ask the team if there is room for you to scrub in, grab the retractor, try to fill in the space of an intern.
- Don't be a show off or put down other rotators, answer only when asked a question, and don't ask questions just to showcase that you read something.

- Knowing Koval, Browner, Campbell's, Miller are fine and dandy but that has no bearing on who we usually rank. We want people who we can get a long with, someone we can trust when they are our juniors on service, and who will make great ortho interns. As far as knowledge goes, you are responsible for anatomy...period. Anything else is gravy.
 
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excellent points in previous post. agree 100%.

- don't suck up, be friendly, upbeat but not annoyingly so.
- be ready to scrub on any case where they could use the hands
- round with any team that could use the help when you have time
- don't wait to be asked to help - assume the role and get to work - paperwork, scripts, dressings changes, dictate clinic visits, etc.
- be everywhere but be invisible: don't make a point of trying to be noticed, you will be if you're there early and stay late
- no matter how much the residents cut up/rag on each other - don't get involved. you don't know these people well enough to join in (usually)
- be prepared to work 15+ hr days and 100+ hour weeks. this is your interview for 4 weeks so bust your ass
- be nice to everybody! scrub techs, nurses, cafeteria workers, etc. talking behind anybody's back and/or being unprofessional can ruin the reputation you spent weeks trying to build
- know your place. you are a student and owe paying your dues, even as a rotator. scrub and stand, be the retractor-boy, insert the foley and help the tech prep the leg/arm/pelvis, etc.
- be ready to help out in the OR in any way - learn where the supplies are in case you're not scrubbed, help move the pt from bed to table, help walk them to the recovery room, etc
-listen and learn from everybody including the intern that's only done ortho for 1-3 months more than you have. they still know more than you do and may be your chief later on if you match there
- always, always introduce yourself to the scrub tech and get your own gown and gloves after being told there is room to scrub (i always ask the residents before assuming i'm going to scrub)
- be the last one scrubbing
- help out other rotators behind the scenes if you can/need to. trying to show them up will make you look bad, but helping them out will add to your comraderie as a rotating group of students and make you all look better.
- don't ask for favors or time off
- don't show up on days off (if you get them) or stay after they tell you to go home (unless everybody else is staying to do something you could help with)
- show some interest in the city/location outside the residency. take the time to see if that's a place you want to live for 5 years (see above for when to do this)
 
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- round with any team that could use the help when you have time
- don't show up on days off (if you get them) or stay after they tell you to go home (unless everybody else is staying to do something you could help with)

Almost wholly agree, but I think a couple caveats about these two are in order:

1) Rounding with other teams can be a negative thing in some programs. If you round with someone else, and your resident suddenly comes up with something he wants you to do, you won't be there and that potentially can be a negative thing. Alternatively, if your team is having lunch or relaxing, and you're rounding with another team, you'll look like you're sucking up. I would definitely get a feel for the program you're at before you do this, as it may not be acceptable everywhere.

2) Don't show up on your day off, but if you know they have a busy day or are short on residents, make the offer.

One other thing to add:

If the residents invite you to go out for a drink or dinner with them, make absolutely sure that you go.
 
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It seems obvious, but a lot of people (including myself as an MS) don't grasp this. It's good to know anatomy and basic ortho conditions, but that stuff is teachable. Programs in general want people who are loyal, work hard, and are people that would be cool to have a beer with after a 15 hr day in the OR.
 
excellent points in previous post. agree 100%.

- don't suck up, be friendly, upbeat but not annoyingly so.
- be ready to scrub on any case where they could use the hands
- round with any team that could use the help when you have time
- don't wait to be asked to help - assume the role and get to work - paperwork, scripts, dressings changes, dictate clinic visits, etc.
- be everywhere but be invisible: don't make a point of trying to be noticed, you will be if you're there early and stay late
- no matter how much the residents cut up/rag on each other - don't get involved. you don't know these people well enough to join in (usually)
- be prepared to work 15+ hr days and 100+ hour weeks. this is your interview for 4 weeks so bust your ass
- be nice to everybody! scrub techs, nurses, cafeteria workers, etc. talking behind anybody's back and/or being unprofessional can ruin the reputation you spent weeks trying to build
- know your place. you are a student and owe paying your dues, even as a rotator. scrub and stand, be the retractor-boy, insert the foley and help the tech prep the leg/arm/pelvis, etc.
- be ready to help out in the OR in any way - learn where the supplies are in case you're not scrubbed, help move the pt from bed to table, help walk them to the recovery room, etc
-listen and learn from everybody including the intern that's only done ortho for 1-3 months more than you have. they still know more than you do and may be your chief later on if you match there
- always, always introduce yourself to the scrub tech and get your own gown and gloves after being told there is room to scrub (i always ask the residents before assuming i'm going to scrub)
- be the last one scrubbing
- help out other rotators behind the scenes if you can/need to. trying to show them up will make you look bad, but helping them out will add to your comraderie as a rotating group of students and make you all look better.
- don't ask for favors or time off
- don't show up on days off (if you get them) or stay after they tell you to go home (unless everybody else is staying to do something you could help with)
- show some interest in the city/location outside the residency. take the time to see if that's a place you want to live for 5 years (see above for when to do this)

Good god - someone sticky this man's (woman's?) post - no more need for asking how to excel on aways.

SOP
 
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sounds like a lot of work

I put in a 100+ hr week on OBGYN once. I could barely walk back to my apartment each morning (night float service)
 
good point above - i meant only to round with other teams if for some reason you have nothing to do with your team. like if they don't have any inpatients - which would be rare but it can happen. you could ask another team if they could use some help instead of just showing up for morning report.
don't leave your team to go work with some other guys unless they ask you to.
good clarification
 
I agree, very good advice above. We definitely need to get a sticky on this.

Only things I would reiterate/emphasize. As mentioned above, we could care less about you getting a random pimp question correct if you come off as a weirdo. We want cool people that work hard, don't complain, are enjoyable to be around with, and are trustful.

Also, stick to the rules above the whole month. One stray action or comment even on your last day can land you on the DNR (do not rank) list.
 
so it's been a few years since i wrote that above and wanted to add a couple things since it's almost "the season" for rotating:

clarifications:
be the last one scrubbing: this is so the residents can get gowned and gloved and start draping while you are getting gowned and gloved. you probably aren't going to drape out the field, so you will want to stay out of the way at the begining

additions:
- don't be too shy. show some intiative.
- take call so that a student is on every night. find out how the program couples chiefs and juniors. and try to take call with your future chiefs. at our program the current PGY-2s will be the chiefs for the 4th year students as we couple PGY 2-4 and 3-5 most often
- for cying out loud don't try to argue with a resident or try to make a point that you know more than they do. even if you know they're wrong. just let it go. some residents can be dumb (or even lazy) but they are still above you
- not asking for time off includes breaking scrub to go get lunch or go to the gym while everybody else is working. think i'm kidding? i've seen it happen. more than once
- don't bad mouth your home or any other program
- like someone said above, if there is a rep dinner, or party for the residents or something, and you get invited... GO! and have fun!!!
- be yourself. pay attention to how the residents get along with the attendings. there are a lot of good programs out there. find the one where you can be happy for 5 years. and remember all the current residents will be gone by the time you finish.
 
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@gdk what's wrong with showing up to work on your day off?
 
I'm not sure if this will be seen, but I have a question about the "don't ask for time off" point. I have a family members wedding fall on one of my away's, even worse it falls on the first weekend of the rotation. I was told by a few residents at my program that one way to go about it is to let them know ASAP and then offer to be on call every weekend I'm there.

Is there any way to go about attending this wedding and not destroying my perception at this program?
 
I'm not sure if this will be seen, but I have a question about the "don't ask for time off" point. I have a family members wedding fall on one of my away's, even worse it falls on the first weekend of the rotation. I was told by a few residents at my program that one way to go about it is to let them know ASAP and then offer to be on call every weekend I'm there.

Is there any way to go about attending this wedding and not destroying my perception at this program?

I think it really depends on the program. I would take the advice of the residents who are there. If you do that, at least you are showing how well you can take directions... I know it's not an amazing way to show how awesome you are, but it's something.

Unfortunately I think there is always some risk of rubbing people the wrong way, "Oh this kid doesn't think his audition rotation is as important as a wedding.... or he's just trying to get out of rotating on the weekend." No way around that I guess?
 
Every rotation and service is different. When I did aways, it was up to the rotating students to make the call schedule. The inidividual schedule for each service at each hospital is highly variable. For instance, spine and trauma at my hospital are much more structured as far as rounding daily and being there every day. On sports/peds/joints/SE, you’d pretty much have the weekend off unless you were assigned to take call (which is dictated by how you work out the schedule with fellow rotators). Unless you know someone at the program that can advise you on requesting a certain service versus another during that rotation, it might be hard to know how things will pan out. As a resident, I completely understand other life things happen. But it takes away from your ability to shine and become an asset to the program if you’re missing time from when you’re supposed to be there. I think you’re fine if you end up taking the same number of call shifts, but missing rounding on the weekend or leaving early on Friday to make it to the wedding might not go over well. There’s not a perfect solution and it depends on the program, service, and residents you’re working with.
 
Every rotation and service is different. When I did aways, it was up to the rotating students to make the call schedule. The inidividual schedule for each service at each hospital is highly variable. For instance, spine and trauma at my hospital are much more structured as far as rounding daily and being there every day. On sports/peds/joints/SE, you’d pretty much have the weekend off unless you were assigned to take call (which is dictated by how you work out the schedule with fellow rotators). Unless you know someone at the program that can advise you on requesting a certain service versus another during that rotation, it might be hard to know how things will pan out. As a resident, I completely understand other life things happen. But it takes away from your ability to shine and become an asset to the program if you’re missing time from when you’re supposed to be there. I think you’re fine if you end up taking the same number of call shifts, but missing rounding on the weekend or leaving early on Friday to make it to the wedding might not go over well. There’s not a perfect solution and it depends on the program, service, and residents you’re working with.

What're your thoughts on what the poster above mentioned earlier about not showing up on days that you're off. Do you think it comes off as too aggressive if a subI does that?
 
I think that also depends on the situation. If you’re showing up to cases your fellow rotator was supposed to be on, I think that comes off poorly and makes you look like a gunner trying to outshine everyone. There are ways to shine by not putting others down, such as reading and preparing well, being helpful in the right ways while you’re present, showing up early and staying late, being present but not being a slug or a leach, doing things that are helpful without needing to be asked what to do, actually helping out your fellow rotators and helping them become better (if you’re the one that make the team more cohesive and strong, that doesn’t make others outshine you - it makes you an awesome person to be around). Basically, read the situation and use awareness of what’s going on around you. If showing up on a day off does not interfere with another rotator, by all means go ahead if you’ve discussed it with the resident ahead of time. If you’re showing up and getting in the way of other’s educational opportunities, I think it will rub people the wrong way and make you undesireable to be around. I’ve heard such comments come up in rank meetings - incredibly smart and hard working sub-I’s who just went too far and made themselves look like someone that’s only out to help themselves at others’ expense. Don’t be that person.
 
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