How to suceed in my Surgery ROTATION??

[LatinGeorge]

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Hello im new,

Ive been reading all the posts, and i think its very helpfull the info i got here.

But i have to ask you everybody on pointers, tips, advice on how to succeed in my surgery rotation, im starting Feb 1.

What not to do..
what to do..
what do residents like?

everything u can advice me i would recieve it with gratitud.

thank u in advance

greetings from centralamerica

 

[Top Gun]

I'll throw in a few pearls of wisdom:

1.) Show up on time. Have supplies for dressing changes ready before
starting rounds.

2.) Work hard and show interest. Or, if you're not interested, at least fake
it. Read up on your patients, and on pathophysiology, diagnosis, and
treatment of surgical disease. This goes double when you scrub into a
case in the OR. That way, you will be able to answer the inevitable
pimp questions and the attending will know you're interested and
may even allow you to do a bit more than just retract (i.e. suture skin,
maybe even use the bovie). Also, volunteer to do scut work. Residents
are very overworked and appreciate whatever help they can get. And
know what is going on with your patients.

3.) Do not whine or complain. Even if you are tired, haven't eaten in over 12
hours, and haven't had a chance to go to the bathroom, the residents
have it even harder, and will not appreciate your complaints.

4.) Ask appropriate questions. Do not ask simple questions or questions that
you can look up the answer to yourself. But by all means, ask about
things that are unclear to you or about things that genuinely interest
you.

5.) Be a team player. Do not try to be a gunner. Do not steal OR cases
from other students and do not jump in and offer information about
other students' patients. Instead, work together with other students
so that you can maximize your learning experience.

6.) Practice skills like suturing and knot tying, in particular the two-handed
and instrument tie. You may be asked to do it in the OR. And take
opportunities to do procedures when they come along. You'll learn more
and enjoy your rotation more.

7.) Above all, have fun!

 

[smq123]

But i have to ask you everybody on pointers, tips, advice on how to succeed in my surgery rotation, im starting Feb 1.

What not to do..

DON'T LIE!

Never make up stuff. If you didn't do something, say that you're sorry, but you forgot. NEVER pretend that you examined a patient, when you actually didn't. If you forgot to ask the patient an important question, just say that you forgot to ask. You might get yelled at, but so what? The resident will get angry, but he will forget about it in an hour. If you lie, though - the resident will remember that you lied for the rest of the rotation. You will be in BIG trouble, and are likely to get a bad grade.

what to do..

Always think ahead! Try to think what will make things go faster, and do them.

When you go into the operating room, before you scrub in, make sure that the scrub tech has an extra gown for you, and gloves in your size.

When the patient comes into the room, help move the patient onto the operating table. After the patient is on the table, help push the patient's bed out of the OR. It seems stupid, but doing this (on your own, without anyone telling you to do this) can make a BIG impression on the resident.

After the operation is over, fill out a post-op note. (Ask your resident to show you after your first operation; after that, do it by yourself.)

Also, after the operation, ask the anesthesiologist if he is ready for the patient's bed. If he says yes, go out into the hallway and bring the bed back into the room. Help move the patient off of the operating table onto the bed.

Finally - pretend that the patient is YOUR patient, and that you're responsible for them. This will motivate you to read about your patient's disease. It will also motivate you to see the patient every morning, to write a good progress note about the patient, etc. If you feel responsible for some of the patients, you will work harder, and get a better grade. Plus you'll learn more.

what do residents like?

They like helpful, enthusiastic students who don't complain!

Top Gun is right when he says not to complain. I heard that over and over again from residents on both my ob/gyn rotation and my surgery rotation - "You never complained! That's what made it easier to work with you." Don't complain to your intern or your resident.

Buena suerte! 🙂

 

[LatinGeorge]

I'll throw in a few pearls of wisdom:

1.) Show up on time. Have supplies for dressing changes ready before
starting rounds.

2.) Work hard and show interest. Or, if you're not interested, at least fake
it. Read up on your patients, and on pathophysiology, diagnosis, and
treatment of surgical disease. This goes double when you scrub into a
case in the OR. That way, you will be able to answer the inevitable
pimp questions and the attending will know you're interested and
may even allow you to do a bit more than just retract (i.e. suture skin,
maybe even use the bovie). Also, volunteer to do scut work. Residents
are very overworked and appreciate whatever help they can get. And
know what is going on with your patients.

3.) Do not whine or complain. Even if you are tired, haven't eaten in over 12
hours, and haven't had a chance to go to the bathroom, the residents
have it even harder, and will not appreciate your complaints.

4.) Ask appropriate questions. Do not ask simple questions or questions that
you can look up the answer to yourself. But by all means, ask about
things that are unclear to you or about things that genuinely interest
you.

5.) Be a team player. Do not try to be a gunner. Do not steal OR cases
from other students and do not jump in and offer information about
other students' patients. Instead, work together with other students
so that you can maximize your learning experience.

6.) Practice skills like suturing and knot tying, in particular the two-handed
and instrument tie. You may be asked to do it in the OR. And take
opportunities to do procedures when they come along. You'll learn more
and enjoy your rotation more.

7.) Above all, have fun!

Wow 😱🙂🙂 That are some excellent, excellent pointers, They make lot of sense, i will definetly take them!!!...... im actually writting them down and will read them all over again when i start my rotation to not forget them. Thnax for taking the time to give me some feed back!!

u must be a good resident 👍👍👍

cheers!!

 

[LatinGeorge]

DON'T LIE!

Never make up stuff. If you didn't do something, say that you're sorry, but you forgot. NEVER pretend that you examined a patient, when you actually didn't. If you forgot to ask the patient an important question, just say that you forgot to ask. You might get yelled at, but so what? The resident will get angry, but he will forget about it in an hour. If you lie, though - the resident will remember that you lied for the rest of the rotation. You will be in BIG trouble, and are likely to get a bad grade.



Always think ahead! Try to think what will make things go faster, and do them.

When you go into the operating room, before you scrub in, make sure that the scrub tech has an extra gown for you, and gloves in your size.

When the patient comes into the room, help move the patient onto the operating table. After the patient is on the table, help push the patient's bed out of the OR. It seems stupid, but doing this (on your own, without anyone telling you to do this) can make a BIG impression on the resident.

After the operation is over, fill out a post-op note. (Ask your resident to show you after your first operation; after that, do it by yourself.)

Also, after the operation, ask the anesthesiologist if he is ready for the patient's bed. If he says yes, go out into the hallway and bring the bed back into the room. Help move the patient off of the operating table onto the bed.

Finally - pretend that the patient is YOUR patient, and that you're responsible for them. This will motivate you to read about your patient's disease. It will also motivate you to see the patient every morning, to write a good progress note about the patient, etc. If you feel responsible for some of the patients, you will work harder, and get a better grade. Plus you'll learn more.



They like helpful, enthusiastic students who don't complain!

Top Gun is right when he says not to complain. I heard that over and over again from residents on both my ob/gyn rotation and my surgery rotation - "You never complained! That's what made it easier to work with you." Don't complain to your intern or your resident.

Buena suerte! 🙂

Hey, about the lying advice, oh my! i have to tell u, that i would have made that mistake probably!........ thanx for the heads up..

think ahead!!..... good tip.. must definetly will do!,
i tend to do to many questions, i will make good questions , quality questions!

and finally good motivations tip👍



thank you for the pointers!!😀

 

[Top Gun]

Oh, another thing. Scrub nurses rule the sterile field in the OR. Do not touch anything on the Mayo stand, or, I promise you, the scrub nurse will hand your as* to you on a platter. And even though there are a fair number of scrub nurses who are bitter and generally mean to students, don't argue with them! You'll never convince them otherwise, and arguing will only make matters worse. If they tell you you've contaminated yourself, apologize and do whatever they want you to do, whether it is regowning, regloving, or even rescrubbing. On that note, there are pretty cool scrub nurses out there too. If you're nice to them, they'll make an effort to help you.

 

[LatinGeorge]

thats a new one for me!.. sure ill remember it thanx DR!!🙂

 

[boston]

that advice from top gun and smq -- money! great posts. also look in the first few pages of Surgical Recall for tips on how to do well on the rotation.

i would add also: do not try to kiss up - sometimes it is just painfully obvious and makes me want to wince. just be yourself, but be enthusiastic about learning and helping out as a team. as a resident, i care more that you want to learn than whether you want to go into surgery or not. if you go into psychiatry, more power to you. if the 3 months during MS3 are your only months on surgery, your goal should be to be able to recognize common surgical emergencies, maybe initiate the workup and treatment and know when to refer for a surgery consult.

 

[werd]

this is what surgery residents told me one time.... "what's the most important thing for you to do? the most important thing is to help out the residents, to make our lives easier. you help us out, we like you, we talk you up and make you look good to the attendings. everyone wins."
for any clerkship i tried to keep in mind 3 basic goals... 1) learn what you can, 2) help out the residents, and 3) show the attendings you're competent.
cheers and good luck; personally, i really disliked surgery.

 

[dynx]

The keys are...in order:

1. Help the residents. If you help the residents they will help you. They can guide your presentation, point out what things you should include for what attendings, keep you up to date, talk you up, let you go read when nothing is going on. If you don't...we can leave you in the dark (why track you down before rounds about that key piece of info a nurse/consulting doctor just called me on when it costs me time and you're not saving me any?), not help you alter your presentations to the attendings likeings and have you tag around with us for useless ****.

2. Learn to tie before your rotation. Granted, its funny as hell when attendings rip on you in the OR but it doesn't help you out.

3. Don't ask stupid questions. What is a stupid question?..In the OR, anything thats in a text book. You're in the OR...you ask "what are the indications for this operation?"...you're a douche. You're not interested and you don't look interested, you could have looked that up before if you really cared. Anatomy questions if you're disoriented, technical questions, questions about what you're seeing in front of you are fair game. On rounds pretty much everything is fair game. Things come up that you didn't forsee and could not have looked up. However, I think a good rule is 2 questions. you're well rested, the attending is well rested (reasonably) and will likely prattle on...the intern post call is not, and would likely want to stab you with a pen when you get to that 4th question thats keeping rounds going and him from going home.

4. Read. Read goddamn it. Know some ****, I don't want to teach someone thats not interested enough to teach themselves...thats a waste of my time.

5. Have some bandages. Some scissors and tape...thats great too. Don't over do it. Start looking like a pack mule and helpfull becomes both that and ammusing. You look like a pushover. We had one student carrying a full on BAG of supplies constructed by another medical student. WTF? Very helpfull, not reviewed well. Contrary to what seems obviouse we do like people with a touch of self respect left.

6. Go with the flow in terms of scrub nurses. We know. Believe me, we know. When the scrub nurse yells at a student for contaminating themselves...the resident and attending aren't thinking "this students an idiot" we're thinking shut the hell up B*tch and get him a new f*cking gown. Unless you do something really stupid...contaminate yourself, no problem. Contaminate the back table...Issues.

Don't lie isnt a rule. Its just common sense. Don't lie...it won't be forgotten and it will ruin any possibility for you to do anything usefull. You won't be able to take part in Rule 1 above because we won't be able to trust you to do anything.

 

[boston]

wow -- great post by dynx. gold.

i would also add: don't be too nervous. relax. forget the stereotypes about surgery residents / surgeons. maybe there are some hardasses, but for the most part, we are people just like you. only that sometimes we are under a little stress, or pressed for time. that's why sometimes surgery residents can appear curt or impatient. (not to say that it is excuseable, but just try to understand)

i should say relax, but also be alert. be able to crack a joke or laugh. but also be aware when people are stressed and when you might have an opportunity to help. often the resident won't explicitly ask for help but just do it ourselves because it is quicker. but if you know that every morning we taking down a big dressing on the same patient and need 4x4s and tape, it is great to be able to able to anticipate that and have tape and dressings ready without even being asked. ultimately, for me this sort of thing is still secondary to the student having a genuine interest in learning and taking care of the patient.

 

[Tired]

maybe there are some hardasses, but for the most part, we are people just like you.

We are just like you.

Except stronger, smarter, with greater stamina, more confidence, and much greater success with the ladies.

But other than that, just like you.

 

[smq123]

but if you know that every morning we taking down a big dressing on the same patient and need 4x4s and tape, it is great to be able to able to anticipate that and have tape and dressings ready without even being asked. ultimately, for me this sort of thing is still secondary to the student having a genuine interest in learning and taking care of the patient.

I think that they go together - if you are genuinely concerned about taking good care of your patients, you'll think to yourself "What does Mrs. Smith need today? She might need to have her dressing changed - maybe I should find some gauze and some tape...."

 

[Blade28]

We are just like you.

Except stronger, smarter, with greater stamina, more confidence, and much greater success with the ladies.

But other than that, just like you.

👍

I had to jump in here and add the following:

We're like many other doctors in the hospital. We go on rounds, discuss patients, and prescribe medications.

We try to learn from lab results, pathology findings, and x-ray/CT/MRI/ultrasound studies.

Oh, and we can operate. 🙂

 

[smq123]

We're like many other doctors in the hospital. We go on rounds, discuss patients, and prescribe medications.

Fortunately, those rounds tend not to last very long.... 😀

 

[LovelyRita]

Read the first chapter of surgical recall.

And, as mentioned above, for the love of God, learn how to tie a knot. A one-handed knot. With 4-0 monocryl. And a needle driver. So you can have a chance at closing that wound. Otherwise, fuggetaboutit!!!!!!!!😎

 

[smq123]

Read the first chapter of surgical recall.

And, as mentioned above, for the love of God, learn how to tie a knot. A one-handed knot. With 4-0 monocryl. And a needle driver. So you can have a chance at closing that wound. Otherwise, fuggetaboutit!!!!!!!!😎

That depends on your school. At my school, third year med students are expected to tie a 2-handed knot - never a one-handed knot. I think that one-handed knots are interpreted as "showing off" in front of the resident. They'll teach the sub-Is how to tie one-handed knots, but I don't think that many of the third years at my school know how to tie anything besides a two-handed knot or an instrument tie.

 

[Blade28]

They'll teach the sub-Is how to tie one-handed knots, but I don't think that many of the third years at my school know how to tie anything besides a two-handed knot or an instrument tie.

Don't worry, one of us will teach you, one of these days. 🙂

 

[LovelyRita]

That depends on your school. At my school, third year med students are expected to tie a 2-handed knot - never a one-handed knot. I think that one-handed knots are interpreted as "showing off" in front of the resident. They'll teach the sub-Is how to tie one-handed knots, but I don't think that many of the third years at my school know how to tie anything besides a two-handed knot or an instrument tie.

If you want to close with a running subcuticular at the end of a case that I scrubbed, I will let you do everything from start to finish if you can show me that you can get it started with a one-handed knot.

I feel as though as a prospective surgeon, you need to learn to make every movement count, and I get sick of anesthesia sighing and rolling their eyes as we all watch the med student fumble around picking the instruments up and putting them down, and trying to tie a knot, etc, etc.

You definitely wouldn't be showing off in front of me....you'd be making me very happy!!!

Also, I should add, everything I mentioned above is especially pertinent to those interested in surgery. If you're not wanting to become a surgeon, I'll teach you all I can, but I won't expect much from you.

 

[Top Gun]

That depends on your school. At my school, third year med students are expected to tie a 2-handed knot - never a one-handed knot. I think that one-handed knots are interpreted as "showing off" in front of the resident. They'll teach the sub-Is how to tie one-handed knots, but I don't think that many of the third years at my school know how to tie anything besides a two-handed knot or an instrument tie.

Yes, at my school, the surgeons wanted us to learn the two-handed tie and instrument tie, before learning the one-handed one. To them, these were the most basic, and students should master these first. As one surgeon explained to me, "Learn to walk before you learn to run."

 

[njbmd]

At my school, we had a Surgical Society (run by fourth years) that sponsored forums that taught knot-tying (2-handed and 1-handed) to the third-years before they entered rotation. We also set up suture clinics so that you can practice simple interrupted suturing and subcuticular on pigs feet before you started your rotation. Your school may have the same options so check it out.

Things that are useful to know:

• How to scrub (you can get one of the scrub techs to teach you this).
• How to tie minimally a two-handed knot (Knot-tying practice board and book available from the Ethicon website-do a Google search)
• A copy of Surgical Recall for your coat pocket (reading the first chapter is good before you start)
• Read the chapter on Surgery Rotation in First Aid for the Wards (good nuggets of info there).

Things like not lying, showing up on time and getting your work done are SOP for any rotation (not just surgery). Surgery starts early in the morning and you will be required to do overnight call which may be new to you. Get used to getting up early and develop a thick skin (don't take anything personally). No matter what specialty you plan to enter, doing well in surgery can be a great asset. Make yourself a valuable member of the team and contribute to making the team work smoothly. Even if you hate everything about surgery (or any other rotation), the clock is always running and surgery will end. The best thing is to get as much out of the rotation as you can.

 

[throckmorton]

Ok, so yes i am a new poster, 😱. I have lurked and sneakily read posts for some time now avoiding "going public" but i feel it is safe to come out of hiding now. That said, take what I say with a HUGE grain of salt, heck take it with a whole damn salt lick. Anyway, I feel the advice given is crucial. Everything said is worth its weight in gold and if you were to follow the above advice you will do extremely well on any rotation especially surgery. My advice is simple, make sure you know your anatomy! I feel this is an understated importance of surgery. I also feel it is an often neglected area of study. A good solid knowledge of anatomy is the foundation to doing well in surgery and in becoming a surgeon. Study anatomy of cases you know are coming up. And not just basic anatomy, but true spatial orientation is important. When a surgeon cuts a vessel know what it is (or was). Think in layers and definitely understand the idea of the peritoneum. Be able to orient yourself in a case and you will be able to anticipate. Knowing landmarks is also important as well. Pick your case and the first thing to identify is anatomical landmarks. For example, something as simple as a lap choley can go terribly wrong if the right hepatic is cut instead of the cystic. So know your anatomy, follow all the advice above, and READ READ READ READ READ and you will ace your rotation.

 

[Acherona]

Study anatomy of cases you know are coming up. And not just basic anatomy, but true spatial orientation is important. When a surgeon cuts a vessel know what it is (or was). Think in layers and definitely understand the idea of the peritoneum. Be able to orient yourself in a case and you will be able to anticipate. Knowing landmarks is also important as well. Pick your case and the first thing to identify is anatomical landmarks. For example, something as simple as a lap choley can go terribly wrong if the right hepatic is cut instead of the cystic. So know your anatomy, follow all the advice above, and READ READ READ READ READ and you will ace your rotation.

wow on my rotation they don't give a rat's *** how much anatomy you know. I think I was pimped once on courvoisier's sign in the OR. But did you update the list, do you know that patient's hemoglobin, did you pull out that NG like we asked...that's all they care about. Then when you are post-call you "get" to go to the OR. woohoo. Too bad by that point the bowel is a blur and I only have enough energy to prevent my head from flopping into it.

 

[SoCuteMD]

My list of tips for surgery may or may not be helpful, but here goes:

• Show up on time
• If you have to start early in order to get your work done, start early - it's unacceptable to NOT have your work done unless you walked in and one of your patients was critical
• If you walk in and one of your patients is critical (i.e. is 2 days post-op and says "I'm suddenly short of breath") DON'T wait until rounds to alert someone senior to you.
• Make sure your patient is "tucked in" at night and again in the AM when you preround - make sure their IV fluids are running at the right rate, their NG tube is WORKING PROPERLY, and they have their DVT booties on
• On prerounds check ALL outputs AND their color. JP drain, foley, NG tube. Know how much came out of EACH individually and know how to characterize it (sanguinous, serosanguinous, bilious, gastric, etc.)
• Tuck in your patients before you leave in the evening. Do your chart checks for consults in the afternoon so that you can take action on recommendations, make sure your patient has Ambien/Benadryl ordered if they complain about having trouble sleeping, make sure anyone who was NPO just for a test is back to their usual diet. All of this prevents calls about YOUR patient to the person on call.
• Find 5 minutes to read about your patient and the procedure you are walking into. I had surgical recall and the Washington Manual on my PDA for this reason and I could read while anesthesia did their thing. I would pull up any relevant radiology and lab results on the OR computer so that when my senior walked in I could brief them on the patient and they could teach me a little something
• Never argue with a scrub nurse. You've contaminated yourself. Go rescrub, regown, turn around 3 times and kiss her feet if told to do so. You WILL NOT win this fight.
• Do the things that are asked of you that are reasonably related to patient care such as going to get lab results, running stat samples to the lab, checking vitals if nursing hasn't done it, going down to medical records for old admissions. These tasks are NOT scut, they are patient care and NO ONE is above it.
• With that said, if a resident asks you to do something like get their coffee, get them dinner, etc., then it's up to you. I usually did it and when I got back asked about a topic I wanted to learn about "Hey, let's look at this chest x-ray and go over pneumothorax dx and mgmt!" because what was my senior going to say at that point - he would have looked like a jerk if he said no!