Surgery rotation

[KoKoOnaJo]

Set up:it’s my second rotation at a massive hospital, so I am vaguely aware of the layout of the hospital, how my badge works. As a 3rd year medical student… I really don’t know much more. The rotation I am starting is surgery. The hospital does not have a surgical residency program. I’ve been told to show up at 9 AM on Monday.

The first day I find the team (PA , 2 docs, another 3rd year and a NP) … They weren’t where I was told they would be. They seem friendly. I’m invited to come around with them. I followed them into each patient room, answer a few people questions and go home.

The next day, I’m expected to get to the hospital at 7 AM. It’s a surgery day. I’m not sure exactly what to do… The other third year seems to know a little bit more so I follow his lead. We are invited to go in Watch cases, and help as desired. After a few cases of mostly scrubbing in and standing out of the way, I get the opportunity to hold the endoscope thing.

This is the pace of each day for a few days.

Long story short , within the next week or so I get **** on for not knowing enough about the cases, not following up with the patient(pre rounding - post rounding), not knowing enough anatomy, etc… one day I get sent home early for not knowing the name of the patient. The other medical student doesn’t seem to know what’s going on either but he escapes their wrath somehow.

I had very little oversight, how am I supposed to anticipate what does attending expects from me? I asked but they’re expectations are simply not realistic as I don’t have a computer to use (and I don’t know how to chart even if I could)

I’m trying to be a good sport, but I really don’t know what my expectations are…

So one day, I pre-and post around on all the patients, and it ends up being a waste of time as the attending never asked. I was asked to make several presentations which he/she never listened too..

This rotation is like drinking out of a firehose. except worst. Is this normal?

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[PeteytheFish]

My surgery rotation was my first clerkship and it made me want to drop out of medical school. Some pointers:

Pre-round on all of your patients - agree with your attending the day before who they want you to follow and keep following those patients until they discharge. If your attending changes from day to day, choose two or three patients from the service and follow them until they discharge, then pick more. Arrive early enough at the hospital in order to pre-round, no matter when you are told to arrive. That means waking them up, talking to them, doing a quick exam with vitals, and checking their operative site if relevant. Read up on their chart, go and see them if they are in the hospital overnight (post-op, usually), and go to pre-op to introduce yourself to all of your surgical patients for the day. Tell your attending during rounds of there is someone you'd like to present.

On those days when you have surgery, always know your patient's name and why they are having surgery. You won't always get asked but you definitely should know - it's honestly a basic patient safety thing, so treat it as such. Ask your attending for a good resource and look up the surgery beforehand so you know the basic steps (not the details - just the basics and the anatomy). After surgery, follow your patient to post-op and wait to make sure that they are waking up OK and their vitals look good. Then you can leave.

It is always expected that you know your current surgical patient's name, surgical indication, and procedure. You should know roughly what will occur in the surgery and you should be able to name the muscles, blood supply, and innervation of the surgical region. If you have time to look up possible adverse effects, normal side effects, and recovery time, that's good too. If you've prepared and are not asked anything, count your lucky stars, thank yourself for doing some studying (it's all relevant for your Shelf and Step 2), and use whatever you've learned to impress your attending with GOOD but informed questions (no one likes a show-off - ask intelligent questions).

Ask to close port sites (or be shown how if you don't know), pull drains, change bandages. Also find time to check on your inpatients at least one other time in the day so that you can give an update if asked.

Surgery is a hard rotation. Best thing you could possibly do is find an upperclassman who has done a rotation at your site and get the deets. Good luck, and hang in there. You may not come out of this rotation wanting to go into surgery (I sure didn't) but you will come out the other end sadder but wiser. DM me if you have questions.

 

[Smurfette]

Once you are on the service and round on the patients with the team, you should have a general idea of what's going on with them but have a couple patients of your own to know really, really well and follow closely. You should know what cases are on for the next day and divide them up with the other 3rd year. Then go home and learn briefly about the surgery (why is it indicated/major anatomy/risks) to prepare. On surgery rotations, emergencies can change plans quickly so you need to do your best when that happens.

Why do you not have computer access? That is a major problem, and unacceptable. Especially when it's not your first time rotating at that hospital, that is part of getting badge access and everything else, you get EMR access. And at this point in 3rd year, you should know how to write a progress note so if I was your attending, I would be VERY concerned about you if you tell me you have no idea how to do that. What are you doing while prerounding if you have no computer access and can't write notes?

 

[Robin-jay]

I always just E-mailed the attending before starting the surgery rotation what my expectations were, and just proceeded to try and do the best I could according to what he was looking for.

Each attending is different in their expectations.

I have heard of students having to be dismissed early for the reasons you mentioned. The main reason I'm aware of, is either not knowing essentially anything about the case being done, or having really subpar anatomy based on the case you're doing.

However, I don't know anyone personally who has ever been dismissed, and I assume it's pretty rare. I would think most attendings would be more consciencious that 3rd years are not that great in clinic, and especially the OR.

There have been times were I answered questions so poorly that I wonder if a more stringent attending would have dismissed me early.

I would guess it's a mix of you doing below expectations + having a stringent attending.

Either way, as long as you keep improving, I doubt any serious repercussions would ever happen.

 

[FutureInternist]

Do you know how to consult IM?

If Yes, you are >75% of the way to becoming a surgeon already 😂