Asking "smart" questions during surgery

[Syranope2]

I'm an MS3 who will be applying to Gen Surgery next year. During the first month of my surgery rotation this year, I got feedback that I was too quiet in the OR and it made me appear uninterested (which I wasn't - just quiet). During my second month, I made a real effort to ask questions and be involved in the case. At the end of that month, my chief told me that I asked a lot of "dumb" questions during the cases and it showed that I hadn't read to prepare for them. I actually did do a good deal of reading for the cases, so I felt like I knew the answers to most of the questions that I asked, but I didn't know what else to ask.

I don't really know the kinds of questions that I should be asking during the case and I'm worried that I'm going to ask a bunch of "dumb" questions during my sub-I and put on a poor show for the attendings who will write my letters. So what are "smart" questions? Could you give some examples of good, thoughtful questions to ask during a sample procedure, say an appy or chole?

Thanks, I appreciate any responses 🙂

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[filter07]

Unfortunately, being attentive in the OR is often not enough. I too learned the hard way. For something like an appendectomy, you can ask things like, whether they routinely do CT beforehand. Why they decide open vs laparoscopic. What is the rate of negative appys with and without CT. When do you decide to convert to open. When would you decide to extend an incision or make a new one? It's tricky because any question could be due to not reading enough. But usually the "high level" questions are related to decision making, and not anatomy.

 

[dynx]

I felt like I knew the answers to most of the questions that I asked

So you're one of those people eh? This may be one of the most f*cking annoying habits one can possibly have. Don't do it ever again. Think about it this way. You're taking a geography class, you want to seem interested so you raise your hand and ask "what's the capitol of the United States?" Even though you know the answer. You look like a ******. Thats YOU. What you would think of that person...that's what your attending thinks of YOU.

Could you give some examples of good, thoughtful questions to ask during a sample procedure, say an appy or chole?

Thanks, I appreciate any responses 🙂

Step 1: Stand there and pay attention
Step 2: Think about whats going on and why its going on
Step 3: If you dont understand whats going on ask a question to clarify it.

It seems so simple yet the concept is lost on so many people.

As an aside, this post may be an attempt to be funny, if so, you got one by me. If not, contemplate the fact that what you described above is so incredibly lame that some people may think your actual behavior is a good setup for a joke.

 

[Knight_MD]

Ask about controversies, and the opinion of the surgeon. Such as whether or not a purse string should be tied during an appendectomy, or if the bed should be reperitonized after an elective splenectomy...etc.

When studying this stuff, you really don't know which is right before you actually see it with your own eyes with someone telling you why it should or shouldn't be done in a case.

 

[Misterioso]

Don't speak in the OR unless spoken to.

 

[Knight_MD]

That's an even better advice. I attend in the OR with a neighbour surgeon I know, but otherwise, it's better trying to be invisible.

 

[Tigger14]

Ask your resident directly what you can do to present yourself better. Without being there, it is hard to know what precisely is being criticized. It is correct that if you ask questions to which you already know the answer, you will come across badly. However, your resident can help. Also when you do your reading, write down the questions that occur to you. An approach like, "I read about x, but I do not understand how you plan an operation/decide when to do that/know how to evaluate it can also sound better.

Lastly, our attendings will set up special sessions outside of the OR to review topics with the students who indicate an interest. One of my students approached me with "I don't want to kiss a**, but I am interested in surgery". I recommended saying so to the attending, and asking if they could sit down, which they did. The student got one-to-one teaching, and the attending had a solid basis for his evaluation. Also, you avoid the risk in the OR of being inopportune, ignored b/c the surgeons are concentrating, or issues like that. Hope this helps.

 

[toofache32]

Make sure you ask "what's that you're cutting now?" at least every 15 minutes.

 

[driedcaribou]

Based on my experiences:

Bad:
- asking anatomy questions (you should know what you're looking at)
- asking questions at crucial parts of the case
- asking about indications
- asking if you can do things during the case (just don't)
- asking questions you know the answer to (it's really obvious)

Good:
- asking about controversies (excellent point from above)
- asking about surgical techniques
- asking about alternative procedures/therapies
- asking if you can help make the case easier ("can I hold that retractor for you?")

I thought it would be ok to ask to do a few small things like close after you've been with a surgeon a few times... but yea, I would never ask anything like 'can I resect the lung?'.

 

[driedcaribou]

Make sure you ask "what's that you're cutting now?" at least every 15 minutes.

I always offer my female attendings backrubs.

 

[toofache32]

I always offer my female attendings backrubs.

Soooo....you're sexist?

 

[driedcaribou]

Soooo....you're sexist?

I choose the term 'selective'.

Actually, I mentioned backrub today and my male attending asked if he could have one.

Sooooo awkward.

 

[toofache32]

Actually, I mentioned backrub today and my male attending asked if he could have one.

Sooooo awkward.

So....did he enjoy the backrub? 😱

 

[driedcaribou]

So....did he enjoy the backrub? 😱

I didn't stand up afterwards for about 5 minutes because scrubs are just too revealing.