Make it a habit of breaking down each case you’re involved in, notes and in your head. Go through the entire case in your head step by step. Try to actually visualize it. Pictures and not just words. At each step, think about possible pitfalls. Ask yourself how you can avoid them and what you would need to do to fix them. If you don’t know, find out.
When you first start doing this, it’s good to do it the night before, first thing in the morning - while you’re getting ready for work or driving in, and then when you’re scrubbing.
Go through it again after the case. While you’re dictating is a good time. Did the case go the way you pictured it before hand? If not, why? Did something go wrong, was there some reason it diverged? Is your mental picture the problem?
Every time you do the case, the steps should get clearer, and the list of possible pitfalls will grow, but the solutions to these problems will also get clearer.
As you get more experienced, you’ll actually find that combining the steps into larger processes is adequate, so the process is faster and you won’t need to do it as much. I still do this before almost every case (maybe not with a tonsil) because it helps me focus. It’s like a mantra. And it will help you keep organized and keep you focused on what you’re doing during the case.
It is ok to ask your senior residents or staff a question about how something is done or what the pitfalls are, but generally only after you’ve done good, exhaustive research and can’t find an answer. Asking for clarity on a source is better than just asking them to explain it all to you. Some staff docs are ok with explaining, but others will definitely expect you to try hard to figure it out first, before you come to them.
A lot of residency is self-taught and guided rather than directed, but of course you should get some actual didactic edification as well. So while you will be ludicrously busy and tired, you have to make reading and note taking part of your routine.
