Surgery Clerkship Prep

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elegantorchid

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Hi I got my tracks selected not too long ago and I will have surgery first which kinda makes me nervous and I was wondering if I should prepare for it a little by reading a book or something before starting third year (I have a little free time after my step 1's). I have heard mix stories some ppl tell me to just walk in not knowing anything and others have suggested I try to prepare a little. I was wondering what are your suggestions and should I grab a book to do a little light reading before hand.

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In addition to the above, check out the Pestana books (he also does the step 2 CK videos for Kaplan) just to learn about how to think through surgery shelf questions. I had surg first too and had no trouble although the shelf was definitely tough. Clinical questions look a lot like step 1 questions but are actually quite different, requiring you to pick up on more subtle clues to rule things in/out. For step 1 World questions I was used to banging out 90% or more on every block of new questions I did; my first pass through a block of Step 2 World Surgery questions was WAAAYYYY lower! Eventually I learned how to adjust my thought process and did better, but there was definitely a transition period and as such doing some practice questions/vignettes ahead of time may be a good idea.
 
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good,there was definitely a transition period and as such doing some practice questions/vignettes ahead of time may be a good idea.
goo
 
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hey guys thx for the advise. i was busy studying for step 1 so i didn't get a chance to look up this thread and thank you guys before!
 
Uh.. Vascular Surgery? I recommend Surgical Recall and just listening to your surgeon when he talks. I learned a lot more by just briefing myself with the book and then listening/answering questions from my attending. Believe it or not - Surgeons actually do enjoy teaching and find it a relief when you want to learn about procedures/etc from them. Also - sometimes reading up on diseases patients have before cases/during helps, too.
Don't waste your time reading an in-depth Vascular Surgery book - you don't have time and you're not supposed to know THAT much.
 
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Agreed, I did vascular for my surgery rotation and I think pestana and surgical recall are more than enough as your basic read-every-day sources. Obviously, make sure you read and understand the vascular chapters first since that's what you'll be seeing. Make sure you read before every case so you know what's going on. I would also make sure you read up in depth on a few high yield topics using whatever huge surgical text your school has a subscription to (ie. Schwartz, Sabiston, etc.). For vascular, you should learn all about CEA, indications, complications, etc. Know all about AAA and other vessel aneurisms, measurements we care about, when to operate, etc. You will see a lot of diabetes-related vascular disease, so make sure you know about DM and how it's managed. Have a working understand of the bread and butter vessel bypasses they do in the lower extremity. Know your vessel anatomy cold and be comfortable identifying it all on an angio since you'll be looking at these a lot. In clinic you'll also see a lot of venous stasis so be familiar with this. Review some of the major clinical trials for vascular like NASCET, CREST, ASCAS, etc. so you can recite their findings when you get pimped (and you will get pimped on these, though not by name -- knowing the name just makes you look like a rockstar).

That's not a lot of reading - maybe 100 pages or so tops - and should cover the bulk of what you'll encounter on service. Beyond that, just read for your patients, review your anatomy, and stay involved. Ask to scrub every chance you get; even if they say 'no' you still look interested. Most of all, have fun. Vascular is a great service with some really sick and medically complicated patients at times so there's a lot to learn on the floor as well. With every patient, read and make and present your own plan no matter how stupid you feel; this is how you'll learn. Do make an effort to branch out and see other services so you're comfortable with them. The shelf has a lot of trauma and GI and general pre-op and post-op management so the more you see, the better. People say it's a medicine shelf and it really isn't, but it's also not really about surgery either. In the end, the shelf is basically "what should EVERY physician know about surgery regardless of specialty?"
 
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Agreed, I did vascular for my surgery rotation and I think pestana and surgical recall are more than enough as your basic read-every-day sources. Obviously, make sure you read and understand the vascular chapters first since that's what you'll be seeing. Make sure you read before every case so you know what's going on. I would also make sure you read up in depth on a few high yield topics using whatever huge surgical text your school has a subscription to (ie. Schwartz, Sabiston, etc.). For vascular, you should learn all about CEA, indications, complications, etc. Know all about AAA and other vessel aneurisms, measurements we care about, when to operate, etc. You will see a lot of diabetes-related vascular disease, so make sure you know about DM and how it's managed. Have a working understand of the bread and butter vessel bypasses they do in the lower extremity. Know your vessel anatomy cold and be comfortable identifying it all on an angio since you'll be looking at these a lot. In clinic you'll also see a lot of venous stasis so be familiar with this. Review some of the major clinical trials for vascular like NASCET, CREST, ASCAS, etc. so you can recite their findings when you get pimped (and you will get pimped on these, though not by name -- knowing the name just makes you look like a rockstar).

That's not a lot of reading - maybe 100 pages or so tops - and should cover the bulk of what you'll encounter on service. Beyond that, just read for your patients, review your anatomy, and stay involved. Ask to scrub every chance you get; even if they say 'no' you still look interested. Most of all, have fun. Vascular is a great service with some really sick and medically complicated patients at times so there's a lot to learn on the floor as well. With every patient, read and make and present your own plan no matter how stupid you feel; this is how you'll learn. Do make an effort to branch out and see other services so you're comfortable with them. The shelf has a lot of trauma and GI and general pre-op and post-op management so the more you see, the better. People say it's a medicine shelf and it really isn't, but it's also not really about surgery either. In the end, the shelf is basically "what should EVERY physician know about surgery regardless of specialty?"
Do you have a blog or something? I'd totally subscribe.
 
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I also have surgery as 1st rotation. I was thinking of doing UWorld surgery questions while reading thro MTB step 3 surgery section, nms, pestana review, and surgical recall. I wanted to prep for step 2 as I go thro each rotation.
But all that reading seems like an overkill. Is there a book I should just take off my list? I'll be so busy that just doing UWorld and reading all that material seems impossible.
 
Honestly as a 3rd yr student on surgery... My suggestion for OR knowledge/pimp questions-
1. Know your patient - why is your patient in the OR, what case you are doing, pt history
2. The condition your patient has - know more than the name of the condition - understand it, the specifics, the path, the causes, treatment options, etc...
3. Anatomy, anatomy, anatomy - honestly if you know this well, it will get you far with most
4. Basics of surgery - Knot typing, suturing, OR basics
5. Read through, know AND understand - Surgical Recall relevant sections
...anything else is really extra
 
Agreed, I did vascular for my surgery rotation and I think pestana and surgical recall are more than enough as your basic read-every-day sources. Obviously, make sure you read and understand the vascular chapters first since that's what you'll be seeing. Make sure you read before every case so you know what's going on. I would also make sure you read up in depth on a few high yield topics using whatever huge surgical text your school has a subscription to (ie. Schwartz, Sabiston, etc.). For vascular, you should learn all about CEA, indications, complications, etc. Know all about AAA and other vessel aneurisms, measurements we care about, when to operate, etc. You will see a lot of diabetes-related vascular disease, so make sure you know about DM and how it's managed. Have a working understand of the bread and butter vessel bypasses they do in the lower extremity. Know your vessel anatomy cold and be comfortable identifying it all on an angio since you'll be looking at these a lot. In clinic you'll also see a lot of venous stasis so be familiar with this. Review some of the major clinical trials for vascular like NASCET, CREST, ASCAS, etc. so you can recite their findings when you get pimped (and you will get pimped on these, though not by name -- knowing the name just makes you look like a rockstar).

That's not a lot of reading - maybe 100 pages or so tops - and should cover the bulk of what you'll encounter on service. Beyond that, just read for your patients, review your anatomy, and stay involved. Ask to scrub every chance you get; even if they say 'no' you still look interested. Most of all, have fun. Vascular is a great service with some really sick and medically complicated patients at times so there's a lot to learn on the floor as well. With every patient, read and make and present your own plan no matter how stupid you feel; this is how you'll learn. Do make an effort to branch out and see other services so you're comfortable with them. The shelf has a lot of trauma and GI and general pre-op and post-op management so the more you see, the better. People say it's a medicine shelf and it really isn't, but it's also not really about surgery either. In the end, the shelf is basically "what should EVERY physician know about surgery regardless of specialty?"

Yes, exactly. People seem to be under the impression that you need to get the "Surgical" texts for all these things when you really don't. Surgeons (like other doctors in other specialties) just want you to be comfortable with what they do. Vascular surgery was about knowing the field and knowing the anatomy. I was nervous at first but a quick review of the vascular anatomy wasn't difficult. I reviewed the arm anatomy before fistula cases and it was definitely nice to be see it in the OR. It was also kind of cool to see them stimulate the median nerve and see the arm twitch (not purposeful, mind you, just something that can happen). But the pimping was definitely about orientation and knowing what was where. It came down to just looking like you knew something about what they did and what was involved, not about knowing EVERYTHING because Surgeons like to teach.

Honestly as a 3rd yr student on surgery... My suggestion for OR knowledge/pimp questions-
1. Know your patient - why is your patient in the OR, what case you are doing, pt history
2. The condition your patient has - know more than the name of the condition - understand it, the specifics, the path, the causes, treatment options, etc...
3. Anatomy, anatomy, anatomy - honestly if you know this well, it will get you far with most
4. Basics of surgery - Knot typing, suturing, OR basics
5. Read through, know AND understand - Surgical Recall relevant sections
...anything else is really extra

Yeah, I'd also add the "instrument tie" method is not what you should "just know" as they say in Surgical Recall. Getting familiar with hand tie method is definitely helpful not just for Surgery but in Medicine in general. If they let you close - ask for help on suturing/closing. Even if you think you're familiar - ask before you do it and be appreciative that they let you. Saying "Oh yeah, I definitely know how to do that" comes off as "Yeah, that's a waste of my time so you do it".
 
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