1st rotation is surgery

[albe]

---

Members do not see this ad.

Hey guys,

I will be starting my 3rd year on surgery (8 week rotation), and I've heard that it's probably the hardest rotation (makes me a little nervous since I'm not sure what to expect/what's expected of me). I don't know if I want to go into surgery, but I still want to be able to do as well as I can to get good grades/good evaluations.

For those of you who have gone through it, what can I do to prepare for it? I've seen numerous posts about the advantage of having IM before surgery for the shelf, but what can I do in my situation? I'll have a little less than a week before it starts in July.

Thanks everyone and thanks to the person who posted about starting with IM for the idea.

 

[MrBurns10]

I started on surgery and managed to do well in it (still not quite sure how, honestly). Surgery is actually a good one to start on because you get the most time-intensive one out of the way, it's easy H&P and notes-wise, and you learn to build a thick skin early on. A few things that I learned the hard way and that I hope you can avoid:

1. Don't try to make friends. Keep your head down, know your patients, offer to help, and ask the occasional question. I tried to be friendly and was rewarded with "Med students should speak when spoken to." Trust me on this.

2. Don't try to come up with a creative plan for the day. If you stick with "advance diet, ambulate, incentive spirometry" you'll get 90% of it right. I made the mistake of suggesting we d/c a foley one time because I wanted to try something new, and was rewarded with "I'm disappointed in you." On my second week of the year. Trust me on this.

3. Read "Surgical Recall" before every case. Know your anatomy. I made the mistake of reading up on the indications for a procedure or the medical illness itself (e.g. reading up on prostate cancer prior to a prostatectomy) when all I was pimped on in the OR was anatomy. Read up on that other stuff when caring for your patients, but the vast majority of your OR pimp question will be anatomy.

4. Don't be too concerned about your grade. It's when you don't worry about your grade and just learn to learn that you get the best evals.

5. And finally, it's not you, it's them. If someone lashes out at you or says something out of line, brush it off the best you can. Surgery residents lead miserable lives so many can become miserable people. Try to understand the criticism and learn from it, but don't think it reflects on you as a medical student or your potential as a doctor AT ALL. Trust me on this.

Good luck. I wouldn't do surgery again if you paid me. 🙂

 

[dilated]

1. Don't try to make friends. Keep your head down, know your patients, offer to help, and ask the occasional question. I tried to be friendly and was rewarded with "Med students should speak when spoken to." Trust me on this.

2. Don't try to come up with a creative plan for the day. If you stick with "advance diet, ambulate, incentive spirometry" you'll get 90% of it right. I made the mistake of suggesting we d/c a foley one time because I wanted to try something new, and was rewarded with "I'm disappointed in you." On my second week of the year. Trust me on this.

It sounds like you were at a malignant program where people were miserable. Fewer and fewer places are like this. My main resident and I became good friends and we go out drinking when he's on a light month. And the attendings were mostly super nice and had mega-low expectations for third years.

Just go in quietly and get a feel for what your hospital is like. There's a good chance it won't be bad at all.

 

[MrBurns10]

It sounds like you were at a malignant program where people were miserable. Fewer and fewer places are like this. My main resident and I became good friends and we go out drinking when he's on a light month. And the attendings were mostly super nice and had mega-low expectations for third years.

Just go in quietly and get a feel for what your hospital is like. There's a good chance it won't be bad at all.

Yeah, I believe the surgery program at my school is considered "malignant" or, at the very least, hardcore (surg residents still wear white pants and short white coats the first 2 years...). Most of the residents were actually nice. But I got stuck with 3 women chief residents, 2 of which were the notorious bitches of the residency. Ironically, I got along great with one of them as I had learned the above lessons by my 3rd subrotation.

 

[Non-TradTulsa]

My program is definitely non-malignant but I have to say that Surgery was not the best 8 weeks of my life (I already knew on day 1 that I wanted to do Internal Medicine). You do have my sympathy, however - drawing Surgery as your first rotation is really not the ideal. But, you'll get the worst out of the way in the beginning. I know there were times in weeks 4 and 5 when I was nearly in tears because I was so sick of getting up at 3am in order to be at the hospital rounding by 5am.

Here's my tip - you've gotten some good ones, but here are tips from a definitely non-malignant program:

Your attendings and residents are all going to stress that you be in the OR as much as possible. Obviously, being in the OR is their passion and they think that's where you'll learn the most. Trust me, it is not necessarily the best strategy.

What you have heard about the shelf is 100% correct. It's an absolute bear. And there is very little on it (nothing, actually) about actual surgical procedures - because you can't be expected to learn technique at an MS-III level. It's all peri- and post-operative management and how to identify someone who needs surgery. It's pretty much all medicine. You will be at something of a disadvantage not having had your medicine rotation. Pick your books to study and start early. If your program gives you a choice of scrubbing-in on afternoon cases - go study instead. You want to make sure you're on-time for morning rounds, work hard on rounds, keep your residents happy - but, whenever you have an opportunity to go study, DO IT. The days in Surgery are very long - our days were 12 hours bare minimum - and you won't feel like studying when you get home (plus, if your program is like mine, you'll only have an hour or two after you get home and eat dinner before it's time for bed).

The big hassle is that you will undoubtedly use Lawrence's "Essentials of Surgery" for most of your lectures - it's pretty much the standard book. It's useless for the shelf. I very much liked the NMS Case Book (not the review book - that's 600 pages and too much theory - the case book) - very compact and has everything you need. Read it at least twice. If you can get your hands on a bootleg copy of Kaplan's 2000 surgery review by Pestana, that's gold too. Surgical Recall is not that good for the shelf, in my opinion, but it should be your bible before you go into a procedure. The book is designed to get you ready for the pimping you're likely to get, and it's very good at that. It'll weigh your backpack down, but I also recommend dragging your old Netter's with you - also handy before surgeries.

The mitigating factor you have is that, since it's rotation #1 for you, expectations for your performance on wards is going to be considerably lower. Try not to develop too many bad habits - the ultra-brief progress note that is considered perfect for the surgical service will get you flunked on Medicine or OB/Gyn. But - you still have to take the same shelf exam everyone else does, rotation #1 or not.

So, in summary - do what you're told and be where you're expected to be on-time. But, once you've scrubbed your cases for the morning, don't volunteer for extra stuff because you desperately need that time for study. The shelf is what blows nearly everyone's grade. Start on day #1.
Last advice - I was in a small, non-malignant program with students I knew well and liked. Don't get sucked into the drama. I can guarantee that no matter how close you are to other students, by week 4 or 5 the stress is going to get to everyone and tempers will flare big time. Make an extra effort not to piss off the other students and don't hang with them in the student lounge or call room all day long - get some time to yourself in your hospital library.

 

[aikaterine]

I also start on surgery in a few weeks. I've heard that there is a lot of IM on the shelf (or at least having that rotation first is helpful). Is it worth my time to get one of the IM books now and read through as a supplement to the surgery review books (instead of getting something like Lawrence) or should I stick to the surgery books required for the rotation and just focus on pre/post op care? As of right now I'm planning on going into IM, but I'm still considering surgery, so I want to honor in the rotation if possible. Any suggestions?

 

[Non-TradTulsa]

I also start on surgery in a few weeks. I've heard that there is a lot of IM on the shelf (or at least having that rotation first is helpful). Is it worth my time to get one of the IM books now and read through as a supplement to the surgery review books (instead of getting something like Lawrence) or should I stick to the surgery books required for the rotation and just focus on pre/post op care? As of right now I'm planning on going into IM, but I'm still considering surgery, so I want to honor in the rotation if possible. Any suggestions?

My suggestion would be to pick-up the surgery review book as soon as possible. Medicine, while very helpful to have had first, is much broader in scope than surgery. I can't disclose under penalty of death what's on the NBME surgery shelf, but I'll endorse comments I've read before - know your G.I. stuff (GI tract and hepatobiliary dz) cold. Know your trauma cold. The exam is focused on what a general surgeon deals with. A good surgery review book (NMS Case Files, Boards/Wards, First Aid, etc) is based on the subject list that the NBME publishes, so it will guide you to studying exactly what you need to study. The trick is mastering the material in the 8 weeks that you have.

 

[Doctor Bagel]

I really wanted a schedule this year with surgery first because I wanted to get it out of the way. Of the crew at my school who did surgery first, two are going into it, and I think all did at least as well as they've done on other rotations. Coming out of 2nd year, you might know a good chunk of the medicine material anyway, and it's a good prep for other wards based rotations because you learn stuff like fluid and wound management. And as mentioned above, the notes are easy. Just remember to write very different notes on your IM rotation!

As a person who's doing surgery last (not my favorite choice but also not horrible), I think Mr. Burns comments about surgery culture are pretty much spot on even in non-malignant programs. In our other rotations, we're encouraged to mentally act like we're the intern and think of different treatment suggestions -- this is not encouraged in surgery. Also, yeah, while our residents are generally nice, they've definitely less friendly and open than residents in other specialties. I think you'd probably annoy most residents if you try to buddy up with them. The other weird thing with our surgery rotation versus other rotations is that our residents value being left alone above you doing lots of work and helping them out. So sometimes the best thing you can do from an evaluation standpoint is hang out and read rather than follow the residents around.

I think NTT is also right about the scrubbing extra cases thing. If you love scrubbing, then do it, but it might not get you more props than reading and doing well on the shelf. I also agree that there's too much emphasis from the surgery people on the importance of scrubbing lots of cases. If you're not going into surgery, scrubbing cases is about the least educationally productive thing you can be doing.

 

[dilated]

I also start on surgery in a few weeks. I've heard that there is a lot of IM on the shelf (or at least having that rotation first is helpful).

There ISN'T a lot of true medicine on the shelf contrary to what people say. Medicine is helpful to have because it's the most educational rotation. But you're not going to get questions about managing diabetes, LDL levels or lupus.

People call anything that has to do with pathophysiology "medicine" as though a "surgery shelf" would be "Name the following surgical instrument" and "Where do you place your incision for a tracheostomy?".

You are going to get questions about the management and pathophysiology of common surgically treated diseases. Hepatobiliary, GI, etc. There are lots of threads on the best reading material, but you should certainly stick with things that are designed for surgery shelf, not medicine.

 

[Pinkertinkle]

There isn't a lot of time to study while on surgery, that's a big challenge. Start reading NMS surgery cases now.

 

[Buckeye(OH)]

My very first rotation as a third year was not only sx, but urology.

It sucked bad because I literally didn't know ****. Take the criticism well, and use it. I wasn't expecting a stellar eval, but I did the best I could and it worked out ok (not great)

 

[elr1983]

I started on surgery and managed to do well in it (still not quite sure how, honestly). Surgery is actually a good one to start on because you get the most time-intensive one out of the way, it's easy H&P and notes-wise, and you learn to build a thick skin early on. A few things that I learned the hard way and that I hope you can avoid:

1. Don't try to make friends. Keep your head down, know your patients, offer to help, and ask the occasional question. I tried to be friendly and was rewarded with "Med students should speak when spoken to." Trust me on this.

2. Don't try to come up with a creative plan for the day. If you stick with "advance diet, ambulate, incentive spirometry" you'll get 90% of it right. I made the mistake of suggesting we d/c a foley one time because I wanted to try something new, and was rewarded with "I'm disappointed in you." On my second week of the year. Trust me on this.

3. Read "Surgical Recall" before every case. Know your anatomy. I made the mistake of reading up on the indications for a procedure or the medical illness itself (e.g. reading up on prostate cancer prior to a prostatectomy) when all I was pimped on in the OR was anatomy. Read up on that other stuff when caring for your patients, but the vast majority of your OR pimp question will be anatomy.

4. Don't be too concerned about your grade. It's when you don't worry about your grade and just learn to learn that you get the best evals.

5. And finally, it's not you, it's them. If someone lashes out at you or says something out of line, brush it off the best you can. Surgery residents lead miserable lives so many can become miserable people. Try to understand the criticism and learn from it, but don't think it reflects on you as a medical student or your potential as a doctor AT ALL. Trust me on this.

Good luck. I wouldn't do surgery again if you paid me. 🙂

Totally agree with this excellent advice, especially point #5. Many surgeons are totally egotistical, rude, miserable people who see it necessary to belittle and humiliate those below them, in the name of "teaching." Good luck -- maybe your surgical residents/attendings will be better than mine, although I wouldn't hold my breath.

 

[Trinity12]

Hi there,

I didn't read through all the replies so sorry if this was already said. I used to think this was a no brainer coming from my med school so this advice might not be helpful, but the med students where I am for residency, for the most part, are next to useless sometimes.

One of the best things in a med student is when they are HELPFUL. After day 1, when you know what you're doing/where you're going... Get to the ward before your intern, assemble the charts on the cart, get the patient rosters printed or get them from the ward clerk if they print them. Write notes on rounds and do whatever you can to help.

Write your name on the board for the nurses and get them your gloves. Be quiet during the case and don't ask questions unless it's appropriate. After the case try writing the postop orders and the OR note. If you don't know how, ask someone to show you. Help transfer the patient from the OR table to the stretcher and bring them to the recovery room with anesthesia. That can free the resident to get a head start on dictating the case. NEVER leave before the intern/resident unless they tell you to go. Be somewhat interested even if you don't want to do surgery. See consults, see cases. Even if you're primary care or IM bound, surgery can be a good rotation. Learn about postop issues and complications.

I can't stand disinterested students who show up late, never pick up charts and vanish as soon as the case is done, which seems to be the majority of students at my school now. It boggles my mind. As a med student, you might think that you're helpful, but 90% of the time you're slowing the resident down. I end up brushing those students off and basically ignore them because they're just not worth my time. It's the helpful ones who are pleasant to be around that end up getting teaching, or at least that's the case with me.

Oh, and don't stress. Be polite and collegial, but not a suck up. Have fun 🙂

 

[MrBurns10]

My very first rotation as a third year was not only sx, but urology.

It sucked bad because I literally didn't know ****. Take the criticism well, and use it. I wasn't expecting a stellar eval, but I did the best I could and it worked out ok (not great)

haha, uro was my first rotation as well. I'd heard about how urologists are the "most chill" surgeons, so I was looking forward to an easier start to the year compared to some of the more hardcore general surgery subrotations. Boy, was I wrong. Most of the residents were pretty nice, but the chief was terrible. She never gave me any feedback during the 2 weeks I was on the team (despite asking for it), then on the last day spent 15 minutes chewing me out. One thing was I reversed the order of something in my presentation...it would have been nice to tell me after I do it wrong, you know, the first time. And I got yelled at for talking with an attending anesthesiologist during the closing of a surgery I was just observing...apparently, when he asked me questions, I was supposed to respond with "excuse me, but I need to watch this surgery." She's doing a fellowship now in another part of the country, and honestly, my heart still beats fast when I see a woman who looks like her in the hospital cafeteria. It did make it easier when I learned that everybody in the surgery department disliked her.