Some things I learned from my Surgery Rotation

[EricVorheese]

I am at the end of my surgery rotation. There were some valuable lessons I learned that helped make this rotation go pretty smoothly and I thought I could share them for future students.



The clerkship director at our site gave us some great advice on the first day of our rotation - "Avoid the 3 Ls - Late, Lazy, Lie - and at the very least, you will pass"...................you can be the biggest ******* who can't spell surgery to save your life, but if you are on time, do the assigned tasks and don't make s*it up, you will atleast pass



couple other things I have learned to avoid (from watching fellow classmates in my rotation) -

1) don't expect acknowledgement/validation/pat on your back for every little thing you do. There's a guy on my rotation (who ironically wants go into surgery) that has spent his entire time doing this. On some days, he'd be on cloud 9 because a resident bought him lunch while on other days, he'd be cursing out the chief resident and bitch and moan that he/she didn't acknowledge him during rounds.
Fact of the matter is, you should be doing your job (and as a student, that essentially comprises of learning as much as you can and helping out your team as much as you can) for the sake of the patient and your own advancement as a student....NOT to wait for people to pat you on the head and say "good job" or shake your hand during rounds and ask you how your weekend was. I say this because it becomes pretty obvious from the getgo and the residents will pick up on it (I actually heard a chief resident say this guy will be getting a ****ty evaluation because all he does is bitch and moan.) Even the other med students have come to think of this guy as a constant whiner.
Don't be this guy! Ultimately, this isn't family med or peds where people may have time to shoot the breeze and talk to you almost everyday about whats going on in your life over breakfast/lunch/dinner. So don't even expect it. Just put your head down, do the best job you can by taking initiative whenever possible and trust me, your efforts will be noticed and well appreciated.



2) Be proactive. The worst thing that can hinder your education as a clinical student is to sit back and wait for ppl to take you by the hand and lead you through something. I would constantly ask the residents to teach me procedures like putting in central lines/chest tubes etc, to show me how/when/why to manipulate ventilator settings, to let me bovey/suture in surgery..........while my partner (we are broken up into teams of 2 medical students for each surgical team) would complain "they are teaching you so much more 'cuz you are a guy. They don't teach me as much. Its because they asked me what I want to do and I said "Peds" which is such bullsh*it. They shouldn't even be asking that question. Their job is to teach and you know what, regardless of what someone wants to go into, they should suck it up and just teach everyone"
I always found this attitude both amusing and naive for various reasons. I highly doubt residents sit around going "student A wants to go into surgery and student B wants to go into peds.......I will teach student A and ignore student B". They simply lack the time and energy for this kind of effort. The one thing that should be obvious about residents, is that they react to you based one how you approach them. If you go to them and ask for something, majority of them will gladly show you. If you don't, then they won't, its pretty plain and simple. It has nothing to do with gender of specialty preference. It's dumb to sit back and expect THEM to approach YOU and ask you if you want to learn something.
So speak up. Ask them how to put in a chest tube. Ask them why one post-op patient gets a regular diet, while others get TPN. Request them to go over ventilator settings with you and why they are the way they are. Stay one step ahead by taking care of some of their menial work and they will be nice enough to let you suture in the OR.
All you have to do is ask and you will be amazed at how much you will learn from your residents.



3) Look for variety. Obviously you will get exposure to surgeries in your own team, but try not to go for the same surgeries repeatedly (if you keep seeing the same inguinal hernia with mesh repair or radical/total mastectomy over and over again, you will want to shoot yourself, trust me). So if you have some downtime, check the OR schedule to see if there are any cool surgeries that are going on and see if you can scrub in on them (especially some of the subspecialties like ENT/ortho/urology - they have some SICK procedures going on sometimes).



4) Be nice to the nurses (SICU nurses, floor nurses, scrub nurses.....ALL of them) - they will help you/cover your *** for you if they like you.......conversely, they will **** you over if you give them attitude. I know this one nurse who bitch paged a buddy of mine every 15 min one night when he was on overnight call, for the most ridiculous reasons (patient doesn't have a pulse/ox reading!!! the pulse/ox meter was lying an inch away from the patient's finger.....it just needed to be put on the finger), all because he gave her attitude earlier in the day.



5) Surgery shelf - haven't taken this yet. So I will update this part when I am done with it.



Overall, you will get what you put into this rotation. So make an effort, and who knows, maybe you'll love it enough to consider going into it


Regards,
Eric

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[etudiante04]

Thanks for the great advice!

 

[el_chavo]

thanks for the advice. I do surgery next. Did you find it helpful to scrub in on surgeries in the learning process? When I did my surgery weeks (gyn/onc) on gyne and I scrubbed in, I felt like I could see less and learn less if I was scrubbed in.
Any advice on how to avoid this on surgery? I want to scrub in as much as possible and see the variety you talk about, but I don't want to get stuck holding a retractor and looking at the back of the resident's neck and not at the surgery.
thanks

 

[EricVorheese]

thanks for the advice. I do surgery next. Did you find it helpful to scrub in on surgeries in the learning process? When I did my surgery weeks (gyn/onc) on gyne and I scrubbed in, I felt like I could see less and learn less if I was scrubbed in.
Any advice on how to avoid this on surgery? I want to scrub in as much as possible and see the variety you talk about, but I don't want to get stuck holding a retractor and looking at the back of the resident's neck and not at the surgery.
thanks

you will most probably start with retracting, everyone does, no escaping that. However, if you start asking the right questions, regarding technique, timing, details of the procedure (why/when/how) etc, eventually they may ask if you want to cut, bovey, suture because they will see you are genuinely interested and can serve a larger purpose than just as a human retractor (hopefully)



Just ask. Start with the intern, then work your way up the ladder to the PGY-2s, 3s, 4s, chief resident. Sometimes, if the attending is nice enough, you can even ask him/her! Like I mentioned in my previous post, don't stand there and expect them to just hand you the cool stuff to do. You need to work for it.



Couple things to keep in mind - practice some of the techniques before you go in. Not only will that save time, it'll make you look good when the resident/attending doesn't have to teach you as much.

Tying knots is a big one - learn both the one-hand and two-hand ties (but only do the two-hand tie in the OR! they hate it when you try to show off by doing the one-hand tie, reserve that for later just in case). Ask your intern to teach you how to tie knots and they will show you.
Boveying is another one. The first time I got to bovey, I was scared between burning too deep but not cutting deep enough and I got stuck in this wierd limbo of nervously pecking at the tissue. The attending asked the anesthesiologist to give me some atavan for my seizure (luckily my attending was cool enough to joke around but anyone else might have ripped me a new one). So go into the OR when you get a chance and ask the scrub nurses (very very VERY nicely) if you can practice with a bovey. There's a certain technique to it, so learn it.

Know the techniques for even minor things, like cutting sutures with suture scissors...............I know, sounds simple enough right? its just a pair of scissors, how hard can it be? wait till you get in the OR and the attending asks you to cut sutures and you keep snipping away and the damn suture won't give.....at which point, the attending belittles you for saying you are interested in surgery but can't even cut a simple suture.............trust me, there's a technique for it, ask your intern

 

[MacGyver]

thanks for the advice. I do surgery next. Did you find it helpful to scrub in on surgeries in the learning process? When I did my surgery weeks (gyn/onc) on gyne and I scrubbed in, I felt like I could see less and learn less if I was scrubbed in.
Any advice on how to avoid this on surgery? I want to scrub in as much as possible and see the variety you talk about, but I don't want to get stuck holding a retractor and looking at the back of the resident's neck and not at the surgery.
thanks

As long as the total number of people scrubbed in is 3 or less (including med student), you are golden. Avoid surgeries that have 4 or more people scrubbed in, because you wont get to see or do ****, unless its a huge operative field

 

[blz]

yep, i agree with everything you said. i honored surgery with this simple formula:

anticipate your duties and do what you're told + shutup and dont piss anyone off

worked like a charm.

be careful about asking too many questions as that would violate the second part of my formula (ie. pissing someone off).

 

[smq123]

I agree with a lot of what you said. And I think it's really cool of you to share these tips with everyone!

2) Be proactive. The worst thing that can hinder your education as a clinical student is to sit back and wait for ppl to take you by the hand and lead you through something. I would constantly ask the residents to teach me procedures like putting in central lines/chest tubes etc, to show me how/when/why to manipulate ventilator settings, to let me bovey/suture in surgery

But don't be a pest. Particularly not in the OR. Pestering your resident to let you bovIE or suture isn't going to earn you any points either.

Ask them why one post-op patient gets a regular diet, while others get TPN. Request them to go over ventilator settings with you and why they are the way they are.

But also use common sense. If you ask "Why is this patient getting TPN, while Mr. Jones next door is on a regular house diet?" and the resident answers "Ummm...because our patient had 5 feet of necrotic bowel, while Mr. Jones just had a knee replacement. Didn't you read the op note?" then you just look stupid.

Similarly, read up on vent settings before asking questions. It'll keep you from asking really obvious stuff.

3) Look for variety. Obviously you will get exposure to surgeries in your own team, but try not to go for the same surgeries repeatedly (if you keep seeing the same inguinal hernia with mesh repair or radical/total mastectomy over and over again, you will want to shoot yourself, trust me). So if you have some downtime, check the OR schedule to see if there are any cool surgeries that are going on and see if you can scrub in on them (especially some of the subspecialties like ENT/ortho/urology - they have some SICK procedures going on sometimes).

ONLY DO THIS IF THIS IS OKAY WITH YOUR SCHOOL!!!! At my school, there are students who are rotating ONLY on ENT/ortho/urology, and they will NOT appreciate being cut out of a fibular free flap by someone who is supposed to be on the general surgery service, but didn't feel like watching the lap chole going on. That is known as being a "gunner" and will earn you a lot of (well-deserved) hatred.

4) Be nice to the nurses (SICU nurses, floor nurses, scrub nurses.....ALL of them) - they will help you/cover your ass for you if they like you.......conversely, they will **** you over if you give them attitude. I know this one nurse who bitch paged a buddy of mine every 15 min one night when he was on overnight call, for the most ridiculous reasons (patient doesn't have a pulse/ox reading!!! the pulse/ox meter was lying an inch away from the patient's finger.....it just needed to be put on the finger), all because he gave her attitude earlier in the day.

Be polite and be nice, but don't let them walk all over you. Don't let them scut YOU out - are you a nursing student? No? Then why are you fetching ice chips for someone who isn't even your patient, and whom you've never laid eyes on before? Or photocopying stuff that doesn't even pertain to your department?

There is a nurse anesthetist who acts like she's a surgery attending. In other words, she treats me like crap. (Actually, she treats me WORSE than the actual surgeons do - the surgeons have been pretty decent so far.) I feel no need to be nice to her. I don't talk back to her (partly because I don't even acknowledge her presence unless I'm about to walk into her), but I'm not going to bend over backwards to earn her "approval."

And paging someone every 15 minutes to pay him back for his "attitude?" I think it's time to grow up - how old is she? Seven? Eight? Please.

There is a scrub nurse who was so abusive to students that the surgery clerkship director had to have a "meeting" with her to discuss her behavior. There are limits.

Any advice on how to avoid this on surgery? I want to scrub in as much as possible and see the variety you talk about, but I don't want to get stuck holding a retractor and looking at the back of the resident's neck and not at the surgery.

This is unavoidable. Sorry.

Scrub in on a lot of laparoscopic procedures, which have those lovely video towers.

you will most probably start with retracting, everyone does, no escaping that. However, if you start asking the right questions, regarding technique, timing, details of the procedure (why/when/how) etc, eventually they may ask if you want to cut, bovey, suture because they will see you are genuinely interested and can serve a larger purpose than just as a human retractor (hopefully)

But again, don't pester. Don't be a PITA and ask a question every hour.

Tying knots is a big one - learn both the one-hand and two-hand ties (but only do the two-hand tie in the OR! they hate it when you try to show off by doing the one-hand tie, reserve that for later just in case). Ask your intern to teach you how to tie knots and they will show you.

Don't worry about the one-handed knot yet. You WILL look like you're showing off.

Boveying is another one. The first time I got to bovey, I was scared between burning too deep but not cutting deep enough and I got stuck in this wierd limbo of nervously pecking at the tissue. The attending asked the anesthesiologist to give me some atavan for my seizure (luckily my attending was cool enough to joke around but anyone else might have ripped me a new one). So go into the OR when you get a chance and ask the scrub nurses (very very VERY nicely) if you can practice with a bovey. There's a certain technique to it, so learn it.

How do you practice with the Bovie? What did you practice ON??

Using the Bovie is actually pretty similar to using the knife. (I found it easier.) Just use confidence, don't dig in too deep, and let the weight of the knife/bovie do the work.

yep, i agree with everything you said. i honored surgery with this simple formula:

anticipate your duties and do what you're told + shutup and dont piss anyone off

worked like a charm.

And don't whine.

To work towards getting honors, HELP YOUR CLASSMATES OUT. Don't backstab them, and don't screw them over on purpose.

(P.S. These tips work well for OB/gyn too!)

 

[AUdacious]

These are some great tips. Let the residents know what you want to try to see and do. This lets them know that you are interested. Then, show them you are interested by things like practicing your knots and working on handling instruments like opening and closing hemostats quickly. Its not rocket science but its not as easy as you would think either and the more you do, the faster you get. In the middle of the rotation, ask for feedback. This gives you time to work on anything that they suggest rather than waiting until the end when it is to late.

 

[el_chavo]

thanks for all the responses.
really I've already done well with the showing up, getting my work done, helping others as much as I can, and only opening my mouth at appropriate times (though what comes out isn't always the right answer) and I did fine on ob/gyn so I'm not really too worried.
I just want to get as much as I can out of the OR time and was frustrated in gyn/onc.
thanks again for the advice.

-del ocho

 

[Blade28]

Using the Bovie is actually pretty similar to using the knife. (I found it easier.) Just use confidence, don't dig in too deep, and let the weight of the knife/bovie do the work.

Don't forget the cardinal rule when using the Bovie:

Don't past-point!

 

[smq123]

thanks for the advice. I do surgery next. Did you find it helpful to scrub in on surgeries in the learning process? When I did my surgery weeks (gyn/onc) on gyne and I scrubbed in, I felt like I could see less and learn less if I was scrubbed in.
Any advice on how to avoid this on surgery? I want to scrub in as much as possible and see the variety you talk about, but I don't want to get stuck holding a retractor and looking at the back of the resident's neck and not at the surgery.
thanks

Surgical oncology and big abdominal cases can sometimes be good to scrub in on - because they might use the Bookwalter retractor, which opens up the field and relieves the med student of the bulk of retractor duties. (It just leaves you with Yankauer duty.)

Breast cases are often good to do as well - they're easy to see, and require minimal retraction. Even when you are retracting (such as in a mastectomy), you can still see what is going on.

I'm not sure about CT cases or vascular cases. I saw an aortic valve replacement, but that's because my chief resident specifically asked anesthesiology to let me stand on their side. Maybe Blade would have a better answer?

Don't forget the cardinal rule when using the Bovie:

Don't past-point!

Yes sir!

Well, in my case as a student, the cardinal rule when it comes to the Bovie is: remember to ask the scrub nurse if Attending X wants you to suction up his smoke or not....

 

[Blade28]

I'm not sure about CT cases or vascular cases. I saw an aortic valve replacement, but that's because my chief resident specifically asked anesthesiology to let me stand on their side. Maybe Blade would have a better answer?
...
Yes sir!

Well, in my case as a student, the cardinal rule when it comes to the Bovie is: remember to ask the scrub nurse if Attending X wants you to suction up his smoke or not....

(1) Might be interesting to go observe, since it's a frickin' "open-heart surgery" (to use layman terms!) after all! Seriously, though, if you haven't seen a patient's heart get cracked open, it's pretty damn cool. Cardiopulmonary bypass is also a blast to observe, once you get the hang of all the tubing.

I don't know if they'll let you scrub, though - usually depends on how old-fashioned or traditional the attending is. Many of the older guys can be control freaks, so they just want the fellow scrubbed and assisting.

(2) PLEASE do not call me "sir." I've had to correct a couple of my med students for this. PLEASE also do not call me "Dr. Blade28."

But ah yes, suctioning the Bovie smoke...used to be my sole job on my OB/GYN rotation during C-sections. Haven't done it in a while, though.

 

[smq123]

(2) PLEASE do not call me "sir." I've had to correct a couple of my med students for this. PLEASE also do not call me "Dr. Blade28."

I've been practicing the "sir" thing. Some of the attendings seem to like it, but the last (and only) time that I said it out loud, I sounded so phony. I figured practicing on the internet might help - baby steps. Plus, I keep forgetting that you're not an attending yet.

When I was in college, some kid at the grocery store called me "ma'am." I think I was 19 or 20 at the time. (Also keep in mind that I apparently don't look my age - I'm 25 and routinely get carded.) That was weird.

 

[Blade28]

I've been practicing the "sir" thing. Some of the attendings seem to like it, but the last (and only) time that I said it out loud, I sounded so phony. I figured practicing on the internet might help - baby steps. Plus, I keep forgetting that you're not an attending yet.

When I was in college, some kid at the grocery store called me "ma'am." I think I was 19 or 20 at the time. (Also keep in mind that I apparently don't look my age - I'm 25 and routinely get carded.) That was weird.

(1) Exactly! OK for attendings, not so much so for fellows/chiefs/residents/interns. BTW, you're right, most attendings like it. The men do, at least. Some female attendings have chided me for calling them "ma'am" since it makes them feel older.

(2) You're a gal?!

 

[Myempire1]

I also advocate the "shut up" in the OR policy unless spoken to policy. If they ask you if you have any questions, definitely come up with some questions. If they do not know the answer, they will make you look it up. That gives you a good opportunity to look up a review article and present it (in 1-2 lines) the next time you are in the OR.

The test.... Wow. I just took the test today. And as expected, I thought it was pretty hard. Psammoma bodies? How was I supposed to remember what those were? WTF? Mainly, I just didn't have enough time. I was at the 2 hour mark and the proctor said... you have 10 minutes remaining and I had about 15 questions left. So it was a rat race at the end. The last couple questions had blood gas in them. I didn't even read the Q's I just read the numbers and picked accordingly. All I know is that you have to know your stuff cold, so that you know the answers to the Qs before you even read the answer choices. Hopefully I did OK.

 

[Ashers]

(2) You're a gal?!

LOL! Deja vu. At least I wasn't the only one who thought that. She said she was in an OB/gyn thread a while back too.

btw... what's "past-point" with a bovie?

 

[smq123]

(2) You're a gal?!

LOL! Deja vu. At least I wasn't the only one who thought that. She said she was in an OB/gyn thread a while back too.

Why does everyone think I'm a guy?

Trust me, if you met me in real life, there'd be no confusion. I walk, talk, look, and dress like a girl. (Well, normally I dress like a girl. I've been wearing nothing but scrubs lately.)

btw... what's "past-point" with a bovie?

I believe it means not to go past the point of the forceps/hemostats that are picking up the fascia/skin that you are cutting through. You don't know what lies beyond those points, and the fascia/skin is not being tautly held, so don't cut too far. That's the rule that I follow, anyway, and no one has said anything yet.

 

[Ashers]

Why does everyone think I'm a guy?

Trust me, if you met me in real life, there'd be no confusion. I walk, talk, look, and dress like a girl. (Well, normally I dress like a girl. I've been wearing nothing but scrubs lately.)



I believe it means not to go past the point of the forceps/hemostats that are picking up the fascia/skin that you are cutting through. You don't know what lies beyond those points, and the fascia/skin is not being tautly held, so don't cut too far. That's the rule that I follow, anyway, and no one has said anything yet.

I don't know why I made the initial assumption. It might've been the avatar you had up with the painting with the old man. Not that I thought that was you, though. It's kinda weird how people make assumptions like that based on how people type or whatever. In random threads, I'll still see people thinking I'm a guy, even when I have the cartoon girl avatar up. Then TheProwler usually jumps in and says I'd look weird dressed a certain way or whatever, just to prove that he knows me, and I'm a girl.

That makes sense for the bovie. I haven't been able to bovie yet. I had been the smoke sucker/limb holder/patella retractor for my ortho rotation.

 

[Blade28]

Why does everyone think I'm a guy?

Trust me, if you met me in real life, there'd be no confusion. I walk, talk, look, and dress like a girl. (Well, normally I dress like a girl. I've been wearing nothing but scrubs lately.)

Sorry! You just fit in with us macho surgeons so well. I'm sure you do walk, talk, look and dress like a girl.

btw... what's "past-point" with a bovie?

smq123 gave a great explanation!

In addition, you touch the tip of the Bovie to the tissue that you're trying to cut/coagulate...you don't "saw" or "slice" with the Bovie, as is often attempted by those slightly inexperienced.

 

[Blade28]

That makes sense for the bovie. I haven't been able to bovie yet. I had been the smoke sucker/limb holder/patella retractor for my ortho rotation.

I should add that when I'm finishing up a relatively straightforward case and starting to close, I always try to get the med student involved in Bovieing (looking for bleeders, etc.) as well as the usual cutting and tying. Was a thrill for me to use the Bovie as a med student, so I try to impart the same thrill to the students.

 

[TexasTriathlete]

Bovieing?

 

[Blade28]

Yeah, didn't know how to spell that word. Is it even a word?

 

[Thievery Corp.]

So, What do you do if the PA student gets to scrub ahead of you because your attending wants to @#^% her brains out...? Grrrr.

 

[velo]

I too learned valuable things on my surgery rotation

#1: I don't want to do surgery

 

[DoctorFunk]

I too learned valuable things on my surgery rotation

#1: I don't want to do surgery

Me too, me too!

#2: Surgeons are extremely detail-oriented while in the OR. However...

#3: When outside of the OR patients must be coding before the surgery team should be paged to assess the situation or make a medical decision.

 

[Ashers]

#2: Surgeons are extremely detail-oriented while in the OR. However...

#3: When outside of the OR patients must be coding before the surgery team should be paged to assess the situation or make a medical decision.

That's what medicine consults are for.

 

[jocg27]

..

 

[Thievery Corp.]

???
Nevermind. I was just frustrated that my attending asked a PA student to scrub while I had to watch the case and he proceded flirt with her the entire case. And has flirted with her all week...

 

[smq123]

???
Nevermind. I was just frustrated that my attending asked a PA student to scrub while I had to watch the case and he proceded flirt with her the entire case. And has flirted with her all week...

Make friendly conversation with the scrub tech/circulating nurse/CRNA. Subtly drop vague hints that you saw the PA student in STD clinic while on your Infectious Disease elective - be sure to include phrases like "florid condyloma" and "textbook case" and "even impressed the attending". Gossip will quickly (think "forest fire"-quick) reach the attending, who will stop flirting with her, and might allow you to scrub.

 

[fakin' the funk]

btw... what's "past-point" with a bovie?

Smq123 made a nice explanation, I just wanted to add: if you're lucky to get to Bovie much, use the very tip of the blade to touch the tissue between the open hemostats. Move the tip of the blade to and fro no deeper than the plane of the hemostats - going deeper than that is the "DON'T GO PAST POINT!" that you'll get yelled at for. It only takes a light touch (like a scalpel) to cut tissue since you also have the lateral traction being provided by the hemostats to pull the tissue apart.

 

[Blade28]

Subtly drop vague hints that you saw the PA student in STD clinic while on your Infectious Disease elective - be sure to include phrases like "florid condyloma" and "textbook case" and "even impressed the attending". Gossip will quickly (think "forest fire"-quick) reach the attending, who will stop flirting with her, and might allow you to scrub.

Oooh you girls can be so catty.

I love it!

 

[Thievery Corp.]

Wow! I never would have thought of that. Damn, that's pretty good.

 

[smq123]

Wow! I never would have thought of that. Damn, that's pretty good.

Thank you. I'm as surprised as you are to find out that I did learn something from having to use the nurses' locker room for the past couple of months.

********************
I learned that the fastest way for a senior resident to earn the med student's loyalty is to tell the CRNA to stop making fun of the med student as she's doing a sub-q skin closure.



I hope that I remember to do the same for my med students when I'm a resident.

I also learned that if you're chairman of the department of surgery, consistently calling the med student on your team by her first name (and never calling her just "the med student") is the best way to earn a reputation as a "pretty cool person" among the students.

(I had a REALLY great team these past few weeks, if you couldn't already tell.... )

 

[Blade28]

Thank you. I did learn something, after all, from having to use the nurses' locker room for the past couple of months.

********************
I learned that the fastest way for a senior resident to earn the med student's loyalty is to tell the CRNA to stop making fun of the med student as she's doing a sub-q skin closure.



I hope that I remember to do the same for my med students when I'm a resident.

I also learned that if you're chairman of the department of surgery, consistently calling the med student on your team by her first name (and never calling her just "the med student") is the best way to earn a reputation as a "pretty cool person" among the students.

(I had a REALLY great team these past few weeks, if you couldn't already tell.... )

Very true points! I'll often notice the scrub tech/circulator/anesthesia person rolling their eyes and making snide remarks when the med student is doing the subcuticular closure a little more slowly than they'd like, but I have to always tell them to give the student a break. You gotta learn some way, right?

Besides, we don't roll our eyes when the new anesthesia PA/CRNA is learning how to place an IV, or intubate! We try to wait patiently when the circulator can't find the correct suture, or instrument, or dressing. When the scrub tech can't figure out the self-retaining retractor, or loads the needle incorrectly (thus almost sticking the med student/resident/fellow/attending), or takes a while to figure out any new device...we bite our tongues!

And really, learning someone's name (be it a student, nurse, tech, etc.) is really under-rated. Goes a mile towards building rapport.

 

[sga814]

our school divides clinical and shelf scores on transcripts if the clinical grade is higher.. let's say I got an outstanding clinically, but just passing on the shelf... are my chances at matching ruined?

 

[71263]

I have not yet had surgery (will start on 1/2)... however, I have had OB/gyn, and it seems eerily similar, like alot of these lessons can be applied to both...

 

[Blade28]

our school divides clinical and shelf scores on transcripts if the clinical grade is higher.. let's say I got an outstanding clinically, but just passing on the shelf... are my chances at matching ruined?

Your grade depends on the school's policy. When I was in med school, most rotations demanded an "honors" grade on all sections in order for you to get an "honors" for the whole rotation.

Why would you think that a "pass" ony any given rotation would ruin your chances at matching? Which rotation? What field will you be applying to?

 

[Ashers]

I have not yet had surgery (will start on 1/2)... however, I have had OB/gyn, and it seems eerily similar, like alot of these lessons can be applied to both...

Yep yep. Slightly worried for surgery, I saw that one of the residents I'm with for a couple of weeks is really cool, but a few others can be nasty.

For general surgery, is it ok to say that I'm planning on ortho, or basically "something surgical." I usually just start out vague, and then somehow later in the rotation, people find out that I want do go into ortho. Usually it's my friends say somethingl, but on my anesthesia rotation, my preceptor knew me from when I was on my ortho rotation, so he already knew I wanted to go into ortho.

 

[sga814]

sorry, i meant chances for gen surg

Your grade depends on the school's policy. When I was in med school, most rotations demanded an "honors" grade on all sections in order for you to get an "honors" for the whole rotation.

Why would you think that a "pass" ony any given rotation would ruin your chances at matching? Which rotation? What field will you be applying to?

 

[smq123]

I have not yet had surgery (will start on 1/2)... however, I have had OB/gyn, and it seems eerily similar, like alot of these lessons can be applied to both...

They're alike in terms of OR culture, expectations for med students, hours, and overall schedule (i.e. preround at 5 AM, round with team at 6 AM, go to holding area by 7 AM, etc.). The general progress note/post op check is roughly the same too.

The thing that OB/gyn didn't prepare me for is the type of patient that you see. The patients on gyn are generally healthier than the average patient on the trauma service, for example. The gyn patients rarely had any JP drains, rarely got PCAs, never needed TPN, and were rarely in the hospital for more than a week.

Compare this to a gen surg patient, who may have 2-4 JP drains, a PCA (or a "pain ball"), may be on TPN, may be enteric, and may finally leave the hospital after POD #25. (One of the trauma surgery patients - who is still in the hospital as we speak, by the way - is up to POD #48. I think that he is on his third batch of rotating interns.)

The first time I saw a patient with a JP drain, I had no idea what I was looking at/looking for. "Serosanguinous? How am I supposed to differentiate between "serosanguinous" and just plain "bloody"?!? And you want me to "strip" the drain? Sure....I'll get right on that....right after I figure out what it means...."

So OB/gyn definitely helped. But it didn't eliminate the learning curve entirely.

For general surgery, is it ok to say that I'm planning on ortho, or basically "something surgical." I usually just start out vague, and then somehow later in the rotation, people find out that I want do go into ortho. Usually it's my friends say somethingl, but on my anesthesia rotation, my preceptor knew me from when I was on my ortho rotation, so he already knew I wanted to go into ortho.

This is only from my personal experience - but don't hedge and say "something surgical." If you do, it sounds like you're saying that just to sound like you're interested in surgery even though you're really interested in psych or peds. And sooner or later, you'll run into the surgery resident/attending who will press you for a clearer, less vague answer.

A lot of the surgery residents never believed people when they said "I want to do general surgery." They always assumed that people were saying that just to get a better grade.

Just bite the bullet and say ortho. You might get a lot of teasing, but at least you'll have had the guts to be honest, which often earns a fair amount of respect.

 

[Blade28]

For general surgery, is it ok to say that I'm planning on ortho, or basically "something surgical." I usually just start out vague, and then somehow later in the rotation, people find out that I want do go into ortho. Usually it's my friends say somethingl, but on my anesthesia rotation, my preceptor knew me from when I was on my ortho rotation, so he already knew I wanted to go into ortho.

Either is fine. Ortho is surgical, so the G Surg people won't mind. Just say "Ortho."

sorry, i meant chances for gen surg

Of course not! Just apply broadly/widely.

The patients on gyn are generally healthier than the average patient on the trauma service, for example. The gyn patients rarely had any JP drains, rarely got PCAs, never needed TPN, and were rarely in the hospital for more than a week.
...
The first time I saw a patient with a JP drain, I had no idea what I was looking at/looking for. "Serosanguinous? How am I supposed to differentiate between "serosanguinous" and just plain "bloody"?!? And you want me to "strip" the drain? Sure....I'll get right on that....right after I figure out what it means...."

(1) I've always contended that OB patients, for the most part, are completely healthy - they're just pregnant. That's why most leave on PPD #1 or #2.

(2) Easy! Serosanguinous (or "s/s") = serous + sanguinous. I describe it as "cranberry juice" to patients.

 

[Ashers]

Either is fine. Ortho is surgical, so the G Surg people won't mind. Just say "Ortho."

(2) Easy! Serosanguinous (or "s/s") = serous + sanguinous. I describe it as "cranberry juice" to patients.

I've just had so many people tell me I should go into a specialty that "requires me to think," and if I have to do something surgical, do neuro surg or some gen surg specialty, but NOT ortho. After a while of that it got rather discouraging.

It's also amazing how much medical stuff can be described in food terms.

 

[smq123]

(2) Easy! Serosanguinous (or "s/s") = serous + sanguinous. I describe it as "cranberry juice" to patients.

Hmm...cranberry juice. I never would have thought of that! It always seemed more like strawberry juice to me...

The breast fellow was nice enough to give me some advice on how to differentiate "sanguinous" from "serosanguinous" - she told me to look at the JP right after I drop the patient off in the PACU. Whatever is in the drain is most likely frank blood (i.e., sanguinous). Anything lighter/yellower/more translucent than that is "serosanguinous." That made sense, to me at least.

I've just had so many people tell me I should go into a specialty that "requires me to think," and if I have to do something surgical, do neuro surg or some gen surg specialty, but NOT ortho. After a while of that it got rather discouraging.

Who said this to you? Non-surgeons, or general surgeons?

Either way, blow them away on your rotation. It's better to hear "You're NOT doing general surgery? But why - you'd be so good at it!" than "You're NOT doing general surgery? Whew, thank goodness."

 

[Blade28]

Who said this to you? Non-surgeons, or general surgeons?

Either way, blow them away on your rotation. It's better to hear "You're NOT doing general surgery? But why - you'd be so good at it!" than "You're NOT doing general surgery? Whew, thank goodness."

Any general surgeon would be pleased you're going into something surgical. They'd wince if you said "EM," may make a face if you say "IM," and will definitely give you a hard time if you say "OB."

 

[Tired]

I've just had so many people tell me I should go into a specialty that "requires me to think," and if I have to do something surgical, do neuro surg or some gen surg specialty, but NOT ortho. After a while of that it got rather discouraging.

We have that reputation because we cultivate it. But believe me, if it were that easy every General Surgeon around would be doing Ortho cases (our reimbursements are way better, and many more of our patients can actually pay for their surgery).