Advice for 3rd Year Students

[Hawk22]

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Hi all,

I'm a current third year medical student who will be starting Surgery in January writing with a few questions for attendings, residents, interns, and upper level medical students in surgery.

Basically, I'm just writing for general advice on how to do well in the clerkship from your perspective. What are the things that you wish someone would have told you early on in your own 3rd year surgery rotation but you didn't realize until later? I know that the general third year advice still applies, like working very hard, being enthusiastic, not complaining, knowing your patients, getting along well with the team, etc. Here are a few more specific questions:

1. In your opinion, what seperates a good medical student from a "great" medical student on surgery? Other than the things above mentioned above.

2. What do you recommend that your students read? I know that most students swear by Surgery Recall for day to day pimping and I've heard good things about NMS Surgery, BRS Surgery, and Lawrence's General Surgery text. I also know that most students say you don't have much time to do much reading or studying, so things have to be very efficient. How do you recommend that your students study and learn about surgery outside the OR?

3. Any essential palm software or small pocket reference books to carry around in our white coats?

4. Any websites that you recommend for your students? Anything on general references, surgical techniques, suturing, or anything else?

Any other general advice would be greatly appreciated as well. Thanks so much!

 

[Pilot Doc]

I'm writing for general advice on how to do well ... What are the things that you wish someone would have told you early on in your own 3rd year surgery rotation but you didn't realize until later?

Both Recall and Lawrence have thorough sections about this, and I don't have much to add. Don't be discouraged when you read them - they represent an ideal student that I have never seen. My only additional recommendation is developing your skills of observation and anticipation. Study the workings of your team in detail, learn to predict what will happen next and do what you can to help. A good example is dressing changes. [Almost] every time a dressing is removed a new one is placed. So when your chief is examining a wound, you should be collecting supplies to redress it. When someone is laying a bandage on the wound, a strip of tape should be hanging at the ready from your outstreched hand. This sounds like scut - and much of it is - but the process of learning to think two steps ahead of the game is invaluable. It will also ingratiate you to your colleagues. Surgery is a team sport, and successful "players" help get the work done - and learn in the process.

1. In your opinion, what seperates a good medical student from a "great" medical student on surgery? Other than the things above mentioned above.

98% is the things mentioned above and intangibles (good sense of humor, etc.) Hard work - as defined by surgery residents, not other med students - and a positive attitude covers multiple sins, though.

2. What do you recommend that your students read? ... How do you recommend that your students study and learn about surgery outside the OR?

I liked Recall and Lawrence. Lawrence is really wonderfully well written. Take the books apart for easy portability. Kinko's will debind and holepunch Lawrence for a minimal fee, making it easy to carry a chapter in your coat. If you have the discipline, the best time to read is in the morning before rounds - get up 30-60 minutes early and read. It's easier to do in the AM than PM. Also, when not in the OR try to follow the consult resident and not the intern. Seeing new patients with (or even better - before) the consult resident is much more educational than watching the intern tinker with pain med orders or try to chase down a CT read.

3. Any essential palm software or small pocket reference books to carry around in our white coats?

Nothing apart from the usual med stud items - maxwell's and a pharmacopeia (sp?). Save your coat space for reading material - see #2

4. Any websites that you recommend for your students? Anything on general references, surgical techniques, suturing, or anything else?

Well ... I learned to scrub from the Cornell University veterinary school web site. (B!tchy OB chief wouldn't help me.) I don't know of any useful ones - again - spend your time with Lawrence and Recall.

 

[mcindoe]

Hi all,

I'm a current third year medical student who will be starting Surgery in January writing with a few questions for attendings, residents, interns, and upper level medical students in surgery.

Basically, I'm just writing for general advice on how to do well in the clerkship from your perspective. What are the things that you wish someone would have told you early on in your own 3rd year surgery rotation but you didn't realize until later? I know that the general third year advice still applies, like working very hard, being enthusiastic, not complaining, knowing your patients, getting along well with the team, etc. Here are a few more specific questions:

1. In your opinion, what seperates a good medical student from a "great" medical student on surgery? Other than the things above mentioned above.

2. What do you recommend that your students read? I know that most students swear by Surgery Recall for day to day pimping and I've heard good things about NMS Surgery, BRS Surgery, and Lawrence's General Surgery text. I also know that most students say you don't have much time to do much reading or studying, so things have to be very efficient. How do you recommend that your students study and learn about surgery outside the OR?

3. Any essential palm software or small pocket reference books to carry around in our white coats?

4. Any websites that you recommend for your students? Anything on general references, surgical techniques, suturing, or anything else?

Any other general advice would be greatly appreciated as well. Thanks so much!

1. Don't argue with or challenge your superiors. You will never win. So choose your battles wisely.

2. Treat the scrub nurse as you would treat the attending.

3. Learn and appreciate the underlying psychology of "pimping". Understand that if you answer the attending's question correctly, he or she will follow-up with another question and continue until you get it wrong or just give up. Again, you will never win this game. By all means, answer questions when asked, preferrably correctly, but this will save you from feeling terribly embarrassed or frustrated when people piss all over you in front of others (which happens more frequently in surgery than elsewhere).

4. If you "disappear" throughout the day, don't assume it goes unnoticed.

5. Don't "pass the buck" to your fellow med students. Karma has its place in the hospital, too.

6. Own up to your actions. If you forgot to do something, just be candid and people will still trust you. If you lie, chances are you'll get caught, and that sort of buzz spreads quicker than a staph infection.

7. Your resident is MORE tired than you are.

8. Be careful about who you vent to about how tired you are. See #7.

Best of luck.

 

[Hawk22]

Thanks all of the above advice...its much appreciated.

I especially like the idea of getting up 30 minutes early to read a little bit because I'm a definite morning person. The idea of breaking apart Lawrence is pretty good too.

As far as "the psychology of pimping", I completely understand how we can never win that game. No matter how many questions I answer correctly, I always feel dumb when I get stumped and conviently forget the 5 questions I just answered correctly.

Another follow up question about Lawrence. What do you all think of the Surgical subspecialty Lawrence text? I'm probably not going to buy it because I'll be very happy if I just make it through the General Surgery Lawrence and Recall, but I am doing 2 weeks of urology and 2 weeks of plastics...so I've toyed with reading those sections if I can find a copy to borrow.

The above information is much appreciated from you both. Thanks again.

 

[dry dre]

Lot of good advise above; I'll add my 2 cents, some may be repeats:

1) Lawrence cover to cover, some don't like the style but it has ~all you need to know to ace the written (if your program uses the natl exam). Know Lawrence cold. . .it's more or less stuff you've learned as an MS1-2. There is some ortho/gas/ent on the exams, but if you're solid elsewhere, they won't hurt you.

2) Pertinent Lawrence (or other text) chaper BEFORE you encounter the case. Since you have December/holidays to read, I suggest GB, breast, trauma, fluids, and all the other early chapters BEFORE you start the rotation.

3) Trauma tends to be a high yield subject in general and is usually emphasized on exams/orals (in my experience).

4) Whenever someone is being nice and tells you that you can go, STAY! At the same time, if you think you're getting under foot, ask what menial tasks you can do elsewhere to help the resident/staff instead of leaving.

5) Always take initiative and do your best to exercise good judgement. Hard work doesn't just mean being an ox. . .surprise your superiors with taking care of things before they ask or even think something needs to be done.

6) Ignore your whiner classmates who hate surgery and call you a gunner etc.

7) ALWAYS know your patients better than anyone (same with every rotation). Always know the surg, med, pharm, and allergy history. At very minimum always know the AMPLE information and the indication for surgery, even if you're scrubbing at the last minute. Note cards are fine if you can't remember. Cards show initiative and responsibility, not weakness. If someone says otherwise, ignore them and let them make mistakes.

8) Ask a med student or resident very early on (maybe in December) how to write the op-note and complete this during or immediately after the case. This is busy-work that will be much appreciated if you complete. At minimum, write the outline (assuming you're in a paper hospital).

9) Learn to write some standard post-op orders. Again, ask a senior med student or resident. If nothing else, write the outline. An easy way to cheat in the first days of your rotation is to copy some standard orders that have been written by staff for the individual cases and note the different in fluids, pain control etc that varies with each type of case so that you may get a head start in writing your orders.

10) Whenever everyone is taking a break in the lounge etc, never join them. Find something to do, or break out a book and read rather than joining the conversation. It's understood and respected that you take learning seriously.

11) Don't be a tool. When in doubt, you're probably being a tool if you think you might be.

12) Have fun and don't stress. The rotation may be the most time/energy intensive, but it should be the most rewarding. If not, think about emergency med.


I think by taking the initiative to even post your questions here that you'll likely rock the rotation. Good luck!

 

[Blade28]

Some great advice already posted in this thread. Things that I did during my third-year surgery rotation:

Separated Lawrence stapled and carried around one chapter at a time in my white coat...that way, I'd always have something to read. Having the entire Lawrence textbook in my backpack wouldn't have been any help.

Carried around Recall everywhere I went.

Helped out the fourth-year med student, intern and residents as much as possible. Let them know if I needed to disappear for a while.

Pre-rounded before the residents every morning.

Tried to be aggressive in the OR, asked to practice cutting, tying, suturing, using the Bovie, etc.

Other tips:

Learn the basic format of the post-op note, post-op orders, etc.

Answer your pager!

Even if you're getting beat down in the OR, or are getting killed during pimp sessions, don't complain.

Treat the nurses like your residents or fellow students.

Before each case, try to read up on the indications, basic anatomy and complications.

 

[tripod]

Good advice but I disagree with what someone said above about "When someone says you can go, STAY!"

When you are told to go home, that means go home. I know as a resident, that when I tell a med student to go home, not only am I doing them a favor, but it also usually means that you are 1) annoying me 2) can't do any more meaningful work for the day 3) annoying me. Usually, when a resident asks "would you like to go home now," it's not a request. Personally, it's pretty aggravating when you have a gung-ho smiley medstudent staring at you with a silly grin while you dictate charts when you already told them to go home.

 

[FutureNobel]

Figure out the key people involved in your evaluations, and prioritize your ass-licking to make sure they are at the top.

 

[SocialistMD]

Always take initiative and do your best to exercise good judgement. Hard work doesn't just mean being an ox. . .surprise your superiors with taking care of things before they ask or even think something needs to be done.

I agree with this, but focus more on the latter than the former. You will be remembered much longer for taking initiative and screwing up than for taking initiative and doing it well. For example, do not go into a patient's room and remove his/her chest tube without first clearing it with your intern/resident. That is not the kind of initiative that will win over your residents. Asking, "So, can I remove [patient x's] chest tube?" prior to doing it is the way to go; it shows initiative as well as judgment (I know this seems like common sense, but I have heard of people taking initiative too far).

Showing good judgment is just as important as showing initiative, and it will be the factor that saves you when your zeal is about to get the best of you.

 

[LovelyRita]

Good advice but I disagree with what someone said above about "When someone says you can go, STAY!"

When you are told to go home, that means go home. I know as a resident, that when I tell a med student to go home, not only am I doing them a favor, but it also usually means that you are 1) annoying me 2) can't do any more meaningful work for the day 3) annoying me. Usually, when a resident asks "would you like to go home now," it's not a request. Personally, it's pretty aggravating when you have a gung-ho smiley medstudent staring at you with a silly grin while you dictate charts when you already told them to go home.

I've experienced both extremes, "go home" and "go home-but-I'm-testing-you-to-see-if-you'll-stay, i.e. do you really want to be a surgeon".

So, I would say that sometimes attendings/residents are hard to read, and I've made it practice to say "OK, but I'd love to stay and help if I can be of help". If I'm still told to go home, then I go. At least I said the truth.

Also, thanks to everyone so far for the good tips. I will partake.

Happy Holidays....
M.

 

[dry dre]

So, I would say that sometimes attendings/residents are hard to read, and I've made it practice to say "OK, but I'd love to stay and help if I can be of help". If I'm still told to go home, then I go. At least I said the truth.

This is what I meant to say above. At the same time, if you're in surgeonesque manic mode, you can see if any other resident/staff needs help (depending on the scheme of your program). A prime goal would be to never ever get underfoot, or follow your senior towards a toilet (we've all been there).

Ditto on the initiative as discussed by Socialist. Hell, when I meant initiative, I meant fetching numbers or following up on loose ends, not procedures 🙂

 

[MegaColon23]

I'm new to SDN. I'm a 3rd year student starting to set up my 4th rotations.

Does anyone know what is the usual way of going about doing "showcase" rotations? I'm interested in General Surgery, so should I do a general surgery rotation/sub-i at all the places I'm interested in doing a residency, or can I just doing an elective rotation and still get in to know the surgical people at the places of interest? This confuses me because if I went about the former way, then I would only have a couple months to do electives in which I'll never get to do in a surgical residency.

Thanks for any input.

MSIII

 

[dry dre]

I'm new to SDN. I'm a 3rd year student starting to set up my 4th rotations...

MSIII

First off, bust tail in 3rd year and get good letters etc. . .

Whether or not/when to do an outside rotation depends a bit on where you want to do residency. If your desired programs are not exactly competative, rotating there may not be necessary to match there if you have good numbers/letters etc. Of course, if your application looks weak and/or the program is competative, you would be doing yourself a favor to rotate at your favorite programs.

Since you are new to SDN, I recommend searching the archives looking for members who may be at the programs you are interested in. There seems to be, more or less, someone on SDN who either is at a particular program, rotated through a program, was a med student in the same location as a program etc etc etc. Given that programs and politics vary, their specific insight would be golden.

 

[mcindoe]

1. Don't argue with or challenge your superiors. You will never win. So choose your battles wisely.

2. Treat the scrub nurse as you would treat the attending.

3. Learn and appreciate the underlying psychology of "pimping". Understand that if you answer the attending's question correctly, he or she will follow-up with another question and continue until you get it wrong or just give up. Again, you will never win this game. By all means, answer questions when asked, preferrably correctly, but this will save you from feeling terribly embarrassed or frustrated when people piss all over you in front of others (which happens more frequently in surgery than elsewhere).

4. If you "disappear" throughout the day, don't assume it goes unnoticed.

5. Don't "pass the buck" to your fellow med students. Karma has its place in the hospital, too.

6. Own up to your actions. If you forgot to do something, just be candid and people will still trust you. If you lie, chances are you'll get caught, and that sort of buzz spreads quicker than a staph infection.

7. Your resident is MORE tired than you are.

8. Be careful about who you vent to about how tired you are. See #7.

Just a few more to add to my list:

9. If your attending or resident asks you a question and you don't know the answer, find it.

10. If you still can't find the answer to their question, don't call them until you do. Prove your resourcefulness.

11. Answer your pagers immediately. If you don't have access to a phone, carry a cell phone.

12. Surgeons love wine, not whine.

13. If you dress like a shmuck, expect to be treated like one.

14. Excellence is not a goal, it is an expectation. (at least it is if you want an honors evaluation)