Surgery internship preparation

[rock1234]

Advertisement - Members don't see this ad

Ok all, will be starting surgery internship before rads. Could you please help me with the following:
1. Which book should I read beforehand?
2. How much medicine do I need to know, ie do I also need to know the pocket medicine by heart or are medicine consults often used?
3. What procedures should I know? Am I allowed to call a senior if I'm not comfortable with the procedure such as suprapubic catheters.
4. Is OR time optional? Is it possible to have some down time at the wards instead of scrubbing in?
5. Should I know the medical doses by heart or ok to check them up?
6. I've been invited to lecture at a conference abroad, do I need to take vacation time for this or just thank no to the opportunity?
7. Do nurses always do the blood draws nowadays, Foleys, etc? What should I expect of them?
8. Do I need to log cases?
9. Do I need to take the absite??
10. I just know basic suturing, is this enough?

I'm more than thankful for your help!!! PS. I'm not the typical IR rads person, going for DR but enjoyed surgery the most.

 

[AdmiralChz]

To be completely honest with you, not much will be expected from you at the start of your internship - definitely not this much - but I'll tag @ThoracicGuy and @Winged Scapula who can probably provide better help since they've been seniors on surgical services.

But I'll answer from how things were a few years ago when I was an intern on surgical services:
1) No need to really prepare by reading, just be well-rested heading into the year because it could be tough depending on your program. Read about your patients and know the more exotic ones cold, similar to a medical student but take it a step farther and understand why certain treatment options are being pursued, goals of care and, perhaps most importantly, how you are going to move the patient along for discharge (this includes possibility of rehab/SNF placement, PT/OT evaluation, social worker evaluations - these people are your lifelines!).
2) If you have done well enough in medical school to match IR, then you probably have a solid base of medical knowledge to draw upon. Honestly I doubt you'll come up with initial surgical plans - your job is to get the information, do a focused physical exam and laboratory/imaging review and communicate the pertinent positive and negatives to your seniors/attendings so they can make the decision about what to do.
- The decision to consult Medicine will largely be institutional and service-dependent, but best to run that idea by your seniors. Basically if they need close titrations (meaning changing doses several times a day) of medications - whether for CHF/diabetes/COPD/etc - a medicine consult might be useful. But in some places (like my shop), the consult service isn't very helpful because they are super overloaded with patients.
3) If you attempted any procedure alone as a new intern with the possible exception of IVs you'll probably get a stern talking-to by your senior. Let them instruct you on basic things like wound dressing/VAC changes, ultrasound. Suprapublic catheter placement probably shouldn't be attempted by a general surgery intern.
- As a general rule of thumb, you should NEVER be afraid to call a senior resident or more experienced personnel if you are uncomfortable doing something. Doing otherwise will get you quickly labeled as a cavalier, or worse, dangerous resident. It might be annoying to a senior but be honest with yourself about your skill set - you don't want to cause harm to a patient just to avoid calling a senior resident at night.
4) Again, institutional and service-dependent. At my shop, I seldom went into the OR as the floor was extremely busy and I was the only provider to help. There are other services with PA/NPs on the floor to help and the intern is often needed in the OR to help (i.e. drive the camera during laparoscopic procedures). Surgeons love initiative, so if you want to get involved then head down to the OR if you are done with your floor work.
5) It's OK to look up doses, have a handy reference site on your phone or computer. Many EMRs have common dosing regimens built-in which is very helpful.
6) If you want to go to this conference you need to request the time off from your program ASAP/NOW/YESTERDAY. The sooner you let them know about these sorts of things the better. Depending on your program they might let you go or they might not based on their rules (especially if it isn't a conference related to the field of surgery). Waiting until the week before the conference is a guaranteed no.
7) At my shop, nurses are great and do all of this unless it's very difficult. At other shops (especially where RNs have a more contentious relationship with the docs) this isn't as common. I'd like to believe that the days of the intern running around the hospital drawing his or her own AM labs are largely over, but who knows?
- Be friendly with the nurses on the ward, especially if they've been there a while. They can make some pretty solid suggestions on common issues ("severe constipation after surgery? We usually try X, Y and then if that doesn't work Z"). I started residency on one of the busiest services in the hospital and the nurses absolutely saved my bacon many times because I was friendly and took their concerns seriously.
8) I didn't, but you'd have to ask your program. Will be covered in orientation.
9) I think so, but you'd have to ask your program. I can't imagine that the score would really be worth much since you have a full residency to follow.
10) Basic suturing is fine, I am proficient with instrument and one-handed knots which is all I really needed. If you need more I'd hope the senior would show you.

I didn't intend to make this long of a post! Basically, be positive/interested and be sure to hit every "to do" box or have a reason why it isn't done at the end of the day. Be an active member of the team and take ownership of the patients - that means understanding their surgical and medical issues and the current therapy being employed. This can be a valuable year which can give you more respect for your surgical colleagues and teach you very applicable time-management skills. It can also be stressful with long hours, so come ready to work and don't ask if you can go home early if your work is done. It's only a year, you can do it! Good luck.

 

[ThoracicGuy]

Ok all, will be starting surgery internship before rads. Could you please help me with the following:
1. Which book should I read beforehand?
2. How much medicine do I need to know, ie do I also need to know the pocket medicine by heart or are medicine consults often used?
3. What procedures should I know? Am I allowed to call a senior if I'm not comfortable with the procedure such as suprapubic catheters.
4. Is OR time optional? Is it possible to have some down time at the wards instead of scrubbing in?
5. Should I know the medical doses by heart or ok to check them up?
6. I've been invited to lecture at a conference abroad, do I need to take vacation time for this or just thank no to the opportunity?
7. Do nurses always do the blood draws nowadays, Foleys, etc? What should I expect of them?
8. Do I need to log cases?
9. Do I need to take the absite??
10. I just know basic suturing, is this enough?

I'm more than thankful for your help!!! PS. I'm not the typical IR rads person, going for DR but enjoyed surgery the most.

1. No prereading is necessary before you start. If you must, see if you can get a list of pocket books or such that your program residents use and pick one.
2. You aren't expected to know everything. Your goal is basically to gather information and put it together intelligently for the team (i.e. upper level resident/staff) to interpret.
3. You should be able to put a foley in, change a wet to dry dressing, maybe a peripheral IV. You are not expect to know any invasive procedures. As an intern, I would talk to your upper residents and do it with them until you are comfortable.
4. OR time varies by program, particularly for prelim residents. If you show interest and initiative, chances are better for going in the OR if you'd like. Don't count on any down time. Any down time that you have is time that can be spent on following up on things so that you are ready by afternoon rounds. You want to know about issues before your upper level residents hear about it if possible.
5. It's ok to look up dosing, though with many EMRs, this is somewhat automatic.
6. If you are invited to present, many times your residency program will pay for it as it gets some prestige for them at the conference. Ask your prelim program what their policy is.
7. Usually nurses will attempt IVs and Foleys, but if they can't do it (or you get a lazy nurse that doesn't really want to try) then you'll get called to do it.
8. I expect you should log any cases you get.
9. Program dependent.
10. Basic suturing is enough to start. You'll learn more as you go.

 

[Winged Scapula]

This is probably redundant given the excellent advice above, but "Dr Winged Scapula returning a page"...

Ok all, will be starting surgery internship before rads. Could you please help me with the following:
1. Which book should I read beforehand?

No intern is expected to do some pre-reading. However, if its been awhile since you've been on a surgical service consider brushing up on admission orders, management of cholecystitis, appendicitis, other various "itises".

Most surgical residents will have a pocket handbook/something on their phone. It can be Maxwells (which is great for admission orders/post op notes, etc), On Call Surgery, Wash U Handbook. See what they use in house at your new program.

2. How much medicine do I need to know, ie do I also need to know the pocket medicine by heart or are medicine consults often used?

Variable. We rarely consult except for the most complex patients or those with new medical issues. The medical management you will need to know will be basic stuff like putting patients on their home meds (where appropriate), sliding scales, management of common post operative complications (hypo/hypertension, DVT/PE, MI, infection).

3. What procedures should I know? Am I allowed to call a senior if I'm not comfortable with the procedure such as suprapubic catheters.

LOL..you're not putting in a suprapubic catheter at all, let alone as an intern without supervision. I expect that an intern on a surgical service would be able to do the following:
a) place/remove sutures and staples
b) place an IV
3) place a Foley
4) dressing changes/wound packing
5) drain removal

I do not expect that you've had any experience with A-lines, central lines. If you've never done a procedure you're asked to do, then I expect you act interested but ask for assistance/supervision.

4. Is OR time optional? Is it possible to have some down time at the wards instead of scrubbing in?

Depends on the program but in most cases staff will understand that you aren't exactly interested in going to the OR and your co-terns might be given preference if there was a choice. That being said:

a) if we need a pair of hands, your radiology interested hands are expected to help out and to do so with the attitude that you're a team member and here to do whatever is needed and perhaps even learn something
b) as noted above, surgeons like initiative. So the Catch 22 is that I know you don't want to be a surgeon and aren't really interested in being in the OR, but we think what we do is cool and so your evaluations will be much better if you come down to the OR when the floor work is done, see what we do, update the Chief on unstable patients, etc. and in general act interested. You might learn some anatomy or what we do that would be useful in your future career.

I can't speak for everyone, but if a Prelim intern is found just surfing the internet for personal things when OR cases are going on, it would be looked unfavorably upon.

5. Should I know the medical doses by heart or ok to check them up?

You should look them up. Hubris is dangerous. That said, most EMRs will do this for you but it helps for you to know the common dosages for common meds that you will be using.

6. I've been invited to lecture at a conference abroad, do I need to take vacation time for this or just thank no to the opportunity?

Most interns and junior residents do not get time off for conferences. So it is most likely that you will be expected to do this on your own vacation. You must tell the program *now* because schedules are going to be drawn up soon and see what they say.

7. Do nurses always do the blood draws nowadays, Foleys, etc? What should I expect of them?

Usually unless you are in New York state. They will do these; they will not draw blood from fistulas, draw ABGs or place a PICC or central line. You will learn the culture at your program.

8. Do I need to log cases?

Unlikely but it wouldn't hurt.

9. Do I need to take the absite??

Program dependent; ask your advanced match program and also ask if your score is important. Most non surgical programs don't care but some like to brag that their interns have done well on it.

10. I just know basic suturing, is this enough?

Yep.

 

[TraumaLlamaMD]

In regards to #8, I know my PD has asked even the non-surgery bound prelims in my program to use the ACGME case log. I'm not sure if there are potential consequences for the program or for you (i.e. not getting credit for the surgical prelim year) if this is not done.

 

[Winged Scapula]

In regards to #8, I know my PD has asked even the non-surgery bound prelims in my program to use the ACGME case log. I'm not sure if there are potential consequences for the program or for you (i.e. not getting credit for the surgical prelim year) if this is not done.

Good point there maybe reasons they have to log cases.

 

[rock1234]

Can't thank you enough for your responses!!!! Helped a lot 🙂😍

 

[LucidSplash]

Good point there maybe reasons they have to log cases.

It's now a requirement that interns have to log a certain amount of cases (can be as FA) in the first 2 years. Likely this is the reason for asking non-surgery prelims to log cases.

 

[evilbooyaa]

Good advice by all the folks above.

Getting through surgical intern year as a prelim not going into surgery (and with a locked down plan afterwards) is actually relatively straightforward. The good parts are that outside of basic reading on your patients, you don't have to study for the Absite (you take it but who cares on the score), you don't have to watch videos of the surgeries that you're going to be assigned (especially if the attending knows you are a prelim without operative plans in the future), etc.

Know the service that you're repsonsible for. Stay up to date on floor work. Try to anticipate who is going to get done, and make sure stuff that needs done by upper levels (narc script signatures was my bane) can be done in one fell swoop at rounds or while they're waiting for a patient to roll into the OR. Befriend the nurses as much as you can.

Your job is to make it so that the attending/senior/folks in the OR are having to deal with as little of outside the OR crap as possible.

Have a checklist of **** that needs to get done, then get it done. Try to ensure you don't give anyone a reason to be routinely pissed off at you. Don't do stuff you don't feel comfortable doing (even if it's something 'assumed' to be known like a VAC change or pulling a chest tube); juniors/seniors will be happy to show you how to do a menial task, exactly 1 time, early in intern year.

I certainly wasn't an all star, but I got through it with minimal being yelled at and the least amount of stress I think possible. And given that you're going into radiology, seeing surgical anatomy and correlating that to radiographical anatomy is pretty cool. For me, seeing what a GI surgical procedure entailed (like a Whipple, for example) helps when I'm trying to analyze a post-op pancreas cancer for radiation b/c I have some semblance of an idea of where stuff used to be.