Incoming FM intern with Surgery as first rotation

[Aquarius9017]

Hey all, I just got my residency schedule for intern year. My first rotation is in Surgery, which has me all types of terrified. My surgery rotation in med school was subpar at best. I rarely got to do any procedures at all. Just wanted to see if any current FM residents have any pointers/suggestions on how to best prepare for this rotation. Thanks in advance.

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[manotter]

Congrats on starting residency, an exciting time. Each residency has different goals for their rotations. Since you are already in FM, the focus should be focussed on FM skills instead of trying to convince you to be GS, like in med school.

Some general surgery rotations will have you with the surgeons only. Goals generally range from identifying emergencies, diagnosing appendicitis, gall bladder issues and learn about work ups prior. In the OR, there should be a focus on suturing, and different suturing techniques, instead of the actual surgeries. If your program supports the learning and credentialling, it is possible to work on getting cases for colonoscopies and EGDs.

Beyond that, some programs will be more open to making what you can out of the rotations. There can be a chance to work with anesthesia and potentially work on intubations, as an example.

Overall, you will find out in the first day what they want from you, but it should be in a FM context.

 

[MedicineZ0Z]

This is heavily program dependent but there's almost no way you'll have a truly intense and demanding surgery rotation as an FM resident. At a true teaching hospital, you may have surgery like hours though but the actual workload will not be what they do. At a community shop, you'll probably suture and see a few patients here and there.

 

[guytakingboards]

Hey all, I just got my residency schedule for intern year. My first rotation is in Surgery, which has me all types of terrified. My surgery rotation in med school was subpar at best. I rarely got to do any procedures at all. Just wanted to see if any current FM residents have any pointers/suggestions on how to best prepare for this rotation. Thanks in advance.

Agree with manotter about what your goals should be.

From a practical standpoint, as an off-service intern, I would expect the majority of your time to be "carry the pager and be the floor scut monkey". Also, being your first rotation, you have to learn all the soft skills of being a doctor. I.e. writing notes/orders, admitting/discharging patients, seeing consults (and reporting back to your attendings).

I wouldn't worry about procedures too much at all tbh. If they know you're a 1st month FM resident, they're not gonna give you anything complicated procedure-wise.

 

[topraman]

My take is different - I think you get the most out of residency if you treat every rotation as if it's your specialty (and as an FM doc with our breadth and scope that's not untrue!)

So for surgery that means
- Know your basic instrument names, the general minor and major tray
- Tie well
- Read about the steps of the procedure and potential complications before the case
- Read about the key anatomy of the procedure before the case

You can learn these on your own and practice if you are committed and goes a long way. Scrub in always, in a community setting you can first assist, in an academic center it's less rewarding but still informative. Observe, ask questions, ask to do parts of it (the worst that can happen is someone says no and you'll be surprised how often others just assume you have no interest).

Why bother? At the end of the day even if you never do major surgery, and some FM docs still do, you'll take away
- Surgical, i.e. anatomical thinking, helps with many hospital medicine cases
- Diagnose, refer, and counsel better
- Wound care/management
- Be able to communicate with surgeons better
- Be more confident with office and floor procedures

Limiting oneself latter based on practice setting/community need and interest is one thing, don't do it in residency prematurely.

 

[galactus]

My first block as a FM intern was surgery. I saw patients in ED and managed the floors. It was a lot more medicine than surgical honestly, but I learned a lot, like I/O's of every drain possible lol. Rarely stepped foot in the OR, because the interns mostly did all floor work. Also did surgery clinic and I learned a lot from it. I'd review AAFP board questions on care of the surgical patient if you want to prep, but otherwise you'll be fine!

 

[FrustratedFamDoc]

Know the etilogy, pathogenesis, pertinent questions, preferred imaging and treatments for the common intra-abdominal pathology and you'll be fine. ie, diverticulitis, ischemic colitis, Chron's/UC, pancreatitis, appy, gall bladder, liver disease, portal hypertension, ascites, etc. Also have a general idea about various hernias.

Don't worry yourself with the zebras. The vast majority of a general surgeon's time is spent in the abdomen. Make a list and take a day to review each one, especially the preferred workup and imaging, and you'll be ahead of the curve. Be able to answer the basic questions and how each one of these patients would present.

An otherwise healthy, asymptomatic, normal exam 30 y/o male with a hemoglobin of 9.7 is a problem. Where would you go from here?

If you do nothing else, at least understand the common abdominal badness.