Good surgery rotation and technical skill advice?

[Blunt Dissection]

Wanted to ask any our surgery residents/attendings if they had some little gold nuggets for surgery month, especially with an interest in doing it later. My attending let me close yesterday and even though I practice everyday at home, it was my first time actually closing on a person. A combination of double gloving, nerves, and working with prolene made me feel like I had troll hands while trying to 2 hand tie. I was able to redeem myself a little when told me to try instrument ties too, but I'm trying to avoid looking like a fool next week.

I'd appreciate any advice on working with the different types of suture material and overall general advice for the surgery rotation itself!

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[Philosopher Jagger]

Wanted to ask any our surgery residents/attendings if they had some little gold nuggets for surgery month, especially with an interest in doing it later. My attending let me close yesterday and even though I practice everyday at home, it was my first time actually closing on a person. A combination of double gloving, nerves, and working with prolene made me feel like I had troll hands while trying to 2 hand tie. I was able to redeem myself a little when told me to try instrument ties too, but I'm trying to avoid looking like a fool next week.

I'd appreciate any advice on working with the different types of suture material and overall general advice for the surgery rotation itself!

Current M3, haven't done Surg yet, but this is advice from a peds CT mentor I have. Things he wishes all med students would do, but so few actually do...

1. Read about the cases the night before. Be familiar with technique, concerns, and follow-up problems. (hard to believe not every student does this, right?)

2. Go see the patients yourself before surgery. Do an examination on them. Even if they are in the OR being prepped, just go see them before the surgeon gets there to ensure nothing has changed and they are doing alright. To him, this mostly shows that you care to be there and are invested in the patient's well-being. It's not so much that you'll discover some new finding or lesion, but rather adding a more personal touch to the patient experience, and it takes no time.

Best of luck in the clerkship

 

[Crayola227]

Doing well on surgery is about a lot more that has nothing to do with what you actually do during the surgery itself.

Doing a nice close is just icing on the cake.

Looking like you actually practiced at home despite troll hands when the moment comes, is sufficient.

You don't want to look like you're tripping on your own feet in the OR, sure.

Main thing in the OR is show that you are excellent at observing your surroundings, following what's happening, AND FOLLOWING INSTRUCTIONS WORKING HARD NO BITCHING.

The end. Don't worry about the suturing it comes with time unless you're a two left footer like me.

My highest clinical grade was surgery and you couldn't get as far from a surgeon as you can in me. So take my advice fwiw. Ymv.

 

[Crayola227]

I can't say following instructions, hard work, and preparing for cases, enough.

A lot of people think they have amazing skills and get arrogant and assertive and feel the need to try to take over or show off. Those are the ones that put their hands somewhere they shouldn't and get thrown out of the OR.

Not saying that's you, but just for anyone reading, how to get your head on straight for surgery. They don't like show offs or arrogant people. There is a hierarchy you will observe, you are lowest on it, you want to help, but he humble. Looking like you're trying to be a hot shot gets a med student hip checked faster than you watch.

 

[Blunt Dissection]

One of the tips my current attending gave me on our very first surgical day was to just keep my hands glued to the top of the field. It really does help to overcome the natural instinct to want to help if I just pretended my hands were glued to the field until I was actually instructed to do something. I don't know if I'm in the minority or not, but I feel like of all the specialties in the field of medicine, surgery is one where the hierarchy is completely necessary for patient safety. Watching the flow of a procedure, particularly when the surgeon has to work with scrub nurses that they're not familiar with, shows how chaotic things can get sometimes. When the surgeon does have a team that he is familiar with though, the atmosphere is completely different and there's visibly a ton of trust between the surgeon and his scrub nurses - I mean, to trust that someone is going to put a sharp in your hand without stabbing you in the process is some serious teamwork.

 

[Blunt Dissection]

Just a med student not going into surgery, but on my surgery rotation my senior had us practicing our knots double gloved with soapy water on the gloves. Definitely mimics the real-life scenario a little more closely if that's what was tripping you up.

You know it's actually more of the gloves being too dry that seems to be causing me the issue. Since so far when I get to close, the only thing I've really been doing is holding retractors or keeping my hands on the table. By the end, my gloves are mostly dry and I have a hard time gripping the sutures since I keep grabbing my gloves. Do you think that's because my gloves are too big? I have fairly small hands so I'm already wearing a 7 inner and 6 1/2 outer glove, but I've thought about trying a 6 1/2 inner and 6 outer glove.

 

[swoopyswoop]

Try on different glove sizes. Practice suturing with gloves on, while standing up.
What were you closing with prolene? Do you mean monocryl?

 

[Blunt Dissection]

Try on different glove sizes. Practice suturing with gloves on, while standing up.
What were you closing with prolene? Do you mean monocryl?

We were closing an epidermal inclusion cyst. I actually don't have a ton of problems with monocryl and I think with the prolene or really, any of the suture materials that have a lot of memory, is that I have a hard time keeping the tail out of my way when I start tying.

 

[swoopyswoop]

We were closing an epidermal inclusion cyst. I actually don't have a ton of problems with monocryl and I think with the prolene or really, any of the suture materials that have a lot of memory, is that I have a hard time keeping the tail out of my way when I start tying.

Do you mean nylon? Prolene is not normally used to close skin. Either way, monofilaments, especially thicker ones, can be hard to tie with. If the tail is in your way you can put a clamp on it.

 

[Blunt Dissection]

Do you mean nylon? Prolene is not normally used to close skin. Either way, monofilaments, especially thicker ones, can be hard to tie with. If the tail is in your way you can put a clamp on it.

Maybe I'm mistaken - I actually can't recall now, but the suture was blue hahahaha. I wonder if heavy test fishing line would be a good mimic for the thicker monofilaments. I also think cutting down on my caffeine intake on surgery days will help lol. I never noticed it until last week how unsteady my hand is after 2 Monsters.