Reading before surgery internship?

[Tigger14]

I received excellent advice last time I posted on a related topic.

My question is: What is good reading to prepare one for surgery internship. I swear, my brain is leaking medical knowledge since graduation. I have started with "Tools of the Trade and Rules of the Road" which is a fantastic reminder of basic surgical techniques. Also, Bates, for history and physical.

Other suggestions will help calm me a bit before the dreaded July 1 arrives...

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[tussy]

The important things to read will be the survival things that you'll need when you're on call. Your ACLS and ATLS, approach to chest pain and SOB, electolytes and fluid management, etc. Get out you pocket book and read thru the relevant chapters. Then the first month, as you start to identify huge areas of weakness you your knowledge base, read around those areas.

 

[Winged Scapula]

As an intern, I think the stuff you'll find most valuable probably isn't the book stuff you learned in school.

If you are on a service which requires you to respond to trauma calls, read up on your ATLS protocols (if you aren't required to/haven't taken the course).

IMHO most of the pages you will get in the early days (besides those which are asking you to decipher illegible handwriting and medication errors) are for the basics - pain management, electrolyte balance, low urine output, isomnia, etc.

So...I'd suggest staying away from reading about clinical problems and the like and concentrate on (since you only have about 2 weeks left)...

pain management regimes (ie, what do you give if the patient says what you're giving isn't strong enough, or they're intolerant of opiods, etc.)

bowel regimes (if you're giving a narcotic for long periods many patients will need them; heck, many patients take stool softeners at baseline)

replacement of eletrolytes - is there a protocol? Most commonly replaced ones are K, Mg and Ca.

management of low urine output (do you give fluid boluses or Lasix is the question asked by every intern)

management of insomnia - patients are often unable to sleep in the hospital. Ambien or Benadryl work well, although like all things can have unpleasant SEs.

DTs management/ICU Psychosis - happens around day 3 typically. Lots of your patients may have an alcohol history - either plan for it or don't be suprised when they start going crazy on ya. Its always in the middle of the night.

Antibiotic/Other Med usage - there often seems to be a service preference or perhaps hospital preference. You don't have to memorize the formulary but if you know what's commonly used and available you can save yourself some pages about "non-forumulary" orders.

This should get you started...most of these things are in the Washington Manual for Interns or the Surgical Intern Pocket Guide.

 

[surg]

I have developed a reasonable size library over the years. I listed some books for different purposes, obviously best to go to your local medical bookstore and check them out to see if you like the style. I also tried to include the prices that I recall paying for them, but who knows what they are now. Start from the top and work your way down since most interns spend more of their time taking care of patients than operating on them. So without further ado...

Books I like for intern level:

For day to day management of patients:

The Handbook of Surgical Intensive Care. It is written by the Duke residents. Probably the most formulaic ICU book existent today. Good for those still searching for their own style. It not only tells you to replete the potassium but exactly what to write on the order strip. Also has a decent section with pictures on common procedures (central lines, art. lines, etc) Should run you about $40 and fits in your pocket (sort of, think harriet lane size)

Also the pocket guide that Kimberli mentioned is good if nothing else, for seeing a sample appy dictation (just make sure that's the way you really did it! Know one resident who was so flustered that they dictated their first hernia case like it was in the manual, except that it didn't at all resemble how he did the case!)

For reading up on surgical diseases for rounds and patient decision making:

Current Surgical Therapy by Cameron. Easily one of the most readable (and affordable) general surgery textbooks. Don't use it for reading on basic science as it is skimpy on this, but it is good for a quick 8 page review on diverticulitis management for instance. (About $200)

or my other favorite: Mastery of Surgery (2 volumes) a nice mix of pictures and readable text. A book that you will use throughout your residency, ~$340. New edition this year is blue I think (last one was red)

For reading up on Operative technique:

Chassin's Operative Strategy in General Surgery. A great combination of text and pictures as well as pictures of all the major instruments, etc. New edition out this year I believe, so it might be hard to find (the last edition went out of print a year ago or so). About $200.

Finally just a nice all around compendium to load in your laptop...
ACS Surgery. Comes on CD-ROM or in print directly from the American College of Surgeons. Nice algorithms for care. a little skimpy on basic science, but nice videos of surgery and the purchase gets you a year long quarterly update subscription ~$250

Good luck!

 

[Winged Scapula]

Surg has made some excellent recommendations for texts. Greenfield is our "house" book but a friend got me Cameron and I much prefer it (we were also given Mastery of Surgery but I don't use it much). The Surgical ICU book is GREAT - word for word instructions (not just telling you to do something but HOW).

A word of advice...don't go out and buy a bunch of books before starting internship. If you have a book fund the program will buy some for you, drug reps may give you some (not sure how the new regulations will affect that benefit), family and friends may be sources, etc.

 

[Tigger14]

Thank you so much! I already have some of the information in other forms, and of course, will await the program benefits and generous drug reps for the rest.

 

[droliver]

I would strongly reccomend Cameron's "current surgical therapy" as your primary text. It's the only thing I ever read at length. As Surg notes it is not as detailed on some of the physiology, but that stuff is not useful to me anyway @ this point. Honestly the physiology,endocrine,cytokine, and GI hormone sections in Advanced Surgical Recall are enough to become fluent enough in those topics to crush the inservice & board exams questions on them. You get a number of free publications just for being a resident which have suprisingly relevent & useful articles & discussions (Archives of Surgery, Surgical Rounds, Contemporary Surgery, Surgical Times Newsletter).

Also Marino's "ICU book" is the best introduction to critical care that you will find. Very easy to read & very thoughful format

 

[Oche]

I have access to Cameron "not so" Current Surgical tx that was published in 96', do you think this would be helpful? I know its really not that current.

 

[Z]

I agree with the other people regarding Cameron's Current Surgical Tx. The new edition (black) is a good deal larger than the last edition (blue). This is good in that several new chapters have been added, however, it is more cumbersome to carry around the hospital. Although the 1996 edition is complete, I would not recomend using it only. You should fork over the hundred bucks and get the latest edition. What was current surgical tx in 1996 (really before that when you think about the lead time the authors needed before the book was sent to press) is not current tx today. For basic science, either Greenfield or O'Leary's book are the best IMHO.