what does it mean to impress with a strong 'work ethic' for surgery rotation?

[wrkndply]

what does it mean to impress with a strong 'work ethic' for surgery rotation?

how would one do this?

(was told if interested in surgery, scheduling the rotation early you can impress with a good work ethic (and ppl will be understanding that you have not yet done other rotations) while scheduling it later in 3rd year you have to impress also with medical skill/knowledge.. any thoughts?)

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[operaman]

what does it mean to impress with a strong 'work ethic' for surgery rotation?

how would one do this?

(was told if interested in surgery, scheduling the rotation early you can impress with a good work ethic (and ppl will be understanding that you have not yet done other rotations) while scheduling it later in 3rd year you have to impress also with medical skill/knowledge.. any thoughts?)

I feel like I've answered this same question many times on this forum. Look in the early pages of Surgical Recall and they give a pretty good description. Otherwise it's pretty much common sense:
1) Arrive earlier than anyone senior to you (ie. everyone)
2) Leave ONLY when you've been told to go home by everyone senior to you. This means if the chief says you can leave, double check with the intern to make sure there isn't something you could help with. When asking, phrase it like "hey, what can I do to help you out?" rather than "So, uh, is there anything else you need me to do?" I hope the difference in tone and sentiment is clear.
3) Always arrive to the OR before the patient (and attending) get there. If cut time is 7:30, this probably means be there by 7ish until you learn otherwise; it might be earlier too. Introduce yourself to the nurses, get your own gloves/gown, and be a decent normal human being.
4) READ READ READ. Read about your patients. Read about every patient prior to surgery. You should be able to deliver a concise H&P from memory on any patient you're scrubbed on and discuss why they're having surgery. Read about the anatomy. If able, read about the procedure itself for a general sense of what's going on.
5) Ask residents, when timely/appropriate, to help you learn how to do things like tie knots, suture, etc. Show interest and they will gradually let you do a little more stuff. Practice at home.
6) Pre round. When you get there earlier than anyone else, see all your patients, write notes, etc. Make sure any and all supplies needed for your patients are ready at bedside for rounds. Have other possible needed supplies on your person (this differs between services, so pay attention and ask). If your service carries a wound bucket, learn what goes in it and have it ready before others get there. The student who consistently makes rounds go noticeably faster is half way or more to an H for the rotation.
7) Pay attention at all times. There's no way you can know everything, but you can pay attention and not make the same mistakes more than once. Learn to anticipate the needs of the team. If your chief is checking a wound, he shouldn't have to ask for a light because your light should already be out and turned on.
8) Introduce yourself to the nurses and other floor staff (yet another reason to get there early). As people get to know you and like you, they can help you. Nurses will often know a lot more about what's going on than you do, so always make sure to talk to them before rounds. Chances are they already paged the overnight resident hours ago and your chief already knows, but this is a good way for you to stay in the loop too. Sometimes you may even catch things that didn't make it up the chain.
9) Don't ever look at your phone. Not in the OR. Not on rounds. Never. If you need to look something up, use a hospital computer. Tablets are probably okay.

That's a general idea. More than showing work ethic, I think this stuff ends up making the rotation more fun for you too. You'll get to do more, you'll learn more, you'll know what's going on in the OR, etc.

 

[JJMrK]

That's a great post.

 

[evilbooyaa]

My only nitpick would be on #2.

If the chief has dismissed you...you're dismissed.

Unless you for some reason know that the intern is swamped and needs help, or that the intern was expecting to hear from you.

I agree. Rest of the advice is solid.

MS3s always followed the Chief schedule, and when the chief said you could go, it was recommended the MS3 run and never look back.

MS4/Sub-I is the time to turn into a surgical intern.

 

[DermViser]

what does it mean to impress with a strong 'work ethic' for surgery rotation?

how would one do this?

(was told if interested in surgery, scheduling the rotation early you can impress with a good work ethic (and ppl will be understanding that you have not yet done other rotations) while scheduling it later in 3rd year you have to impress also with medical skill/knowledge.. any thoughts?)

Simple - be a hammerhead: http://doctum-aphorism.tumblr.com/post/24552003854/the-perfect-surgery-student

 

[Armadillos]

While opera's posts are generally too gunnerish for me, I think he is definitely on to something with #9, everyone assumes your texting/FBing when your on a phone. Although I would say maybe just don't let an attending or chief see you using a phone, interns/residents arent going to care.

 

[ChEMD]

While opera's posts are generally too gunnerish for me, I think he is definitely on to something with #9, everyone assumes your texting/FBing when your on a phone. Although I would say maybe just don't let an attending or chief see you using a phone, interns/residents arent going to care.

There's that word again, "gunner". I don't understand how you associate things like paying attention, reading about your patients and being prepared, arriving early, asking questions at appropriate times, asking to be taught procedures, etc...with being a "gunner". Not once did he mention anything about trying to out do other classmates or anything of the sort. No, the things he listed strictly involved hard work and dedication to your education. So while hard work and gunning are often used interchangeably by some people (usually the ones who aren't willing to work as hard), the two should not be confused in an attempt to bring down those who are working harder/performing better than you.

 

[Armadillos]

There's that word again, "gunner". I don't understand how you associate things like paying attention, reading about your patients and being prepared, arriving early, asking questions at appropriate times, asking to be taught procedures, etc...with being a "gunner". Not once did he mention anything about trying to out do other classmates or anything of the sort. No, the things he listed strictly involved hard work and dedication to your education. So while hard work and gunning are often used interchangeably by some people (usually the ones who aren't willing to work as hard), the two should not be confused in an attempt to bring down those who are working harder/performing better than you.

I didn't specifically mean this post, hence why I said "are generally". As for the personal attacks about people performing better than me, I can always solace myself by digging that AOA medal out of my closet. I've always took the work smarter, not harder approach. Thats why I was a huge fan of his #9 advice, great way to be more engaged and look better to everyone without actually having to be around the hospital any extra time.

 

[ChEMD]

I didn't specifically mean this post, hence why I said "are generally". As for the personal attacks about people performing better than me, I can always solace myself by digging that AOA medal out of my closet. I've always took the work smarter, not harder approach. Thats why I was a huge fan of his #9 advice, great way to be more engaged and look better to everyone without actually having to be around the hospital any extra time.

Lol that wasn't a personal attack, it was more of a generalized statement about the people that tend to use the word gunner. But that's awesome that you did well, congrats. Since you did so well, you of all people should understand how calling others who try hard and do well a gunner really isn't fair. But I do agree that it's important to work smart, but that's in addition to working hard (the two aren't mutually exclusive).

 

[mercaptovizadeh]

I'm a resident in a non-surgical field but honored surgery.
1.) take surgery after medicine. the organ systems addressed by the two fields are the same, and oftentimes pimping will touch on management issues (often medical before surgical, sometimes together for cancer treatment, etc.) rather than stereotypical anatomy and technique questions.
2.) Keep your head down and work hard when prerounding. Do all the tasks they ask you to do for pre-rounding - whether to carry around the supplies for wound dressings, helping with bandaging, removing staples, etc. or calculating I/Os and following up WBC counts and cultures
3.) Learn the anatomy for the case.
4.) Ask intelligent questions at appropriate times - not during a stressful part of the operation, when a patient is crashing, and not stupid questions like "what is that?" - they expect you to know the anatomy. but you can definitely ask how good surgery is alone vs. surgery with radiation in the treatment of wilm's tumor
5.) Learn to anticipate. That was the most important part of my surgery clerkship. It is highly valued by surgeons. Get involved hands deep in the operation and really be of assistance, but don't get in the way. Contort your body/hands/retractor so the surgeon can see whatever needs to be seen. Know when to irrigate, when to help cauterize, how close to cut the suture from the knot, when and where to suction and mop up blood without being told to do so. That requires a lot of observation. Watch how the scrub nurse and residents assist and mimic them. And let me reiterate: don't try to be so "helpful" that you get in their way.

One thing I noticed about some of the hyper gung ho "I want to do surgery types" (often with an orthopod bent) is that they have a dismissive attitude to the diagnosis, medical, radiology and pathology, and perioperative management and think it's all about cutting in the OR and learning how to suture. Suturing is not what makes a surgeon. A surgeon is a doctor, not a mere proceduralist, so take an active interest in disease presentation and course, prognosis, epidemiology, appropriate imaging techniques to aid in diagnosis, pathology/genetics, antibiotic management, fluids and electrolytes, pressors in the ICU, anticoagulation, etc. and all the other issues that happen outside of the OR.

 

[stsa84]

I won't speak to "how to impress", as that's been solidly covered. Below are my thoughts on the timing of the rotation you are interested in going into.

I did surgery my first rotation of 3rd year, basically because it let me have my elective at what I considered to be the 'opportune' time (January). If I was interested in surgery, I definitely would schedule surgery towards the end of first semester or beginning of second. I got solid surgery evals, but when I look back on my performance the first month, I kind of cringe. The learning curve of how to effectively manage 3-5 patients, know them better than anyone else, and be able to present them better than anyone else, is pretty steep. It's something that only time and experience can improve. You'll make a much better impression on the service you wish to impress, if you've had a few months to hone your skills. IMO, succeeding in 3rd year is 25% knowledge, 75% "performance". Interviewing, knowing, and presenting patients is all about having a framework and organizing information. It's taken me a few months of practice to feel I've got a good system down, and to feel confident being completely responsible for the patients assigned to me.

 

[Kaustikos]

One thing I noticed about some of the hyper gung ho "I want to do surgery types" (often with an orthopod bent) is that they have a dismissive attitude to the diagnosis, medical, radiology and pathology, and perioperative management and think it's all about cutting in the OR and learning how to suture. Suturing is not what makes a surgeon. A surgeon is a doctor, not a mere proceduralist, so take an active interest in disease presentation and course, prognosis, epidemiology, appropriate imaging techniques to aid in diagnosis, pathology/genetics, antibiotic management, fluids and electrolytes, pressors in the ICU, anticoagulation, etc. and all the other issues that happen outside of the OR.

Hey! They can be taught! We had a particularly moving moment here wherein we explained how easy it is to manage a diabetic with the insulin sliding scale order set. I think the orthopod found it enlightening...
Until he put it in every one of his order sets for every patient.*



*I have no hate to orthopods. They're just funny sometimes.

 

[Apoplexy__]

Simple - be a hammerhead: http://doctum-aphorism.tumblr.com/post/24552003854/the-perfect-surgery-student

The over-the-top idealism in that checklist bothers me like a cheesy film or a couple making out in public. Eeeugh.

 

[DermViser]

The over-the-top idealism in that checklist bothers me like a cheesy film or a couple making out in public. Eeeugh.

I think a lot of it is quite tongue-in-cheek (I hope). That or they have amphetamines readily available.