I see a lot of people really concerned about physical skills on the surgical rotation -- what matters more than doing a suture tie, is
surgical thinking and
surgical management
My school had a ton of didactics about surgery built-in, so that regardless of what happened in the OR, you were learning what needs to be learned from a surgical rotation. It's the stuff that's pertinent to just about every type of practice.
Like, for a given complaint, say, abdominal pain, how are you going to figure out if this is appendicitis vs diverticulitis vs bowel obstruction, and what do you do to diagnose and manage? When do you go to the OR?
How can you tell if a wound is infected vs normal healing?
Managing drains, dressing changes, antibiotics, ambulation, nutrition, working towards dispo. Recognizing complications and that management as well.
You need to understand when you need to consult surgery, how to speak their language, how you medically clear someone, what factors may or may not make someone appropriate for a surgery and why a surgeon may or may not take someone to the OR, basics of surgical and non-surgical management, anatomy, monitoring the post-op course.
These are all things you'll do outpt FM or IM on the floors for crying out loud.
Everyone needs to have some grasp of, or even application of, basic surgical management, all the stuff that happens
outside the OR, this is true for anyone that
refers to surgery, and those who
do the surgery.
I've heard many surgeons say that this aspect is just as important if not moreso, than the actual physical act of having their fist in someone. Granted, that's a technical skill and one that does indeed matter. Seems like a lot of the people who wash out of surgery don't just have an issue of 2 left hands, but the judgement that goes with surgery. Some of that is knowledge-based and you can read a book. Some of it is not and is a special skill the integration of a lot of things and judgement calls.
This is why it's just as important, maybe moreso, to have read up about your patients, their procedures, and do well on rounds and with pimping. That's right, those speed rounds changing dressings, actually matter and are another opportunity for the following.
Really odd to say my best grade was surgery. And it's not because I was born to be a surgeon or have anything even approaching that personality. I was bored to tears during every procedure. But I was knowledgeable about the factors that matter.
- Who is this patient (I don't mean names... I mean from a surgical standpoint)
- Why are they having this procedure, like, why is it justified? What was the medical management that had taken place, and why is this now the thing to do?
- Knowing how to differentiate a complaint, to diagnose and assess when surgery is needed. Imaging.
- Basically medical management and then surgical indications.
- Knowing the anatomy not only lets you navigate it, it is then part of recognizing what complications can take place and what to watch for after the surgery.
- What is it about this patient that poses particular challenges, not only to the procedure, but the course after?
- What can we expect in terms of outcome for this procedure in general, and the patient in specific?
- What are the different ways to address this problem, not just medically, but different surgical approaches? Why is this one being used and not another? Pros/cons to different approaches.
- Specifics on post-op course, recognizing complications, what to do to diagnose or treat those complications.
Learning to be
smart in your questions - you can ask questions that do the following, show that you're interested, but what does that mean? Shows that you've done your homework (I'll post again the sage advice, try not to ask a question that you can easily ask Dr. Google, one that you can teach yourself) on the above topics, and ask the next level question, which will be about integration of knowledge about surgery and the patient, to make a judgement about management. Questions that draw upon the judgement of the surgeon. I'm not talking about reverse pimping them or trying to stump them on some obscure anatomy point. Questions that are specific and relevant to the patient and the procedure, that show that you've done your research on both, and an interest in management, that you've thought about the problem-solving involved.
Understanding surgical thinking and all of this, will be so much more impressive than driving the camera around. I mean, that's cool. From what I can tell, it's not a question of how adept you are at these things, it's more about your confidence and passion for doing them, that goes along with the rest of what I said.
Don't get me wrong, I made a point of learning basic sutures and I think that's helped me on EM and surgical rotations. That said, why does that make you stand out? Because it shows you went above and beyond in your level of interest and commitment to have learned a skill for that specialty (assuming that where you are at is above the level of your peers). But that's only one way to show commitment and interest, and I argue some of these skills are not even really that important in doing so. It's nice if you can stitch well enough to basically not even be watched doing it, as that can save some time and help the team. You can never get past the level of holding a retractor, and still impress your team.
Lastly, but not exactly last, is helping the team. Anticipating needs and not getting in the way, it's a skill, and it's needed more during procedures than other tasks as you learn, but it's needed in all specialties you rotate on.
Working hard. Knowing about your patient can save the team a lot of time in looking things up on the EHR, and that is also where you can show that you care and are working on knowing what you should.
