Surviving Surgery

[JaSam]

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Anybody got any tips on how to go about doing this? I can't stand the hours, can't stand standing, can't stand the people, and can't stand being pimped on the minutia of anatomy. HELP!!!

 

[futuredo32]

Sorry you aren't enjoying your surgery rotation.
Surgical Recall helped me a lot with the pimping. I carried it around in my pocket and would read in between surgeries. I wasn't too fond of all of the standing either. I took Motrin before going in every day and took another dose of Motrin around lunch in addition to buying comfortable shoes. I was lucky and all of the residents and attendings I worked with on my surgery rotation were awesome, I don't have any advice about that.
I'm doing a rotation right now that I don't like too much. It helps me to just count down the days left in this rotation and remind myself that I'll likely never again have to do a rotation in this field.
Good luck.🙂

 

[bigdan]

Anybody got any tips on how to go about doing this? I can't stand the hours, can't stand standing, can't stand the people, and can't stand being pimped on the minutia of anatomy. HELP!!!

Bummer. By the looks of things, you're gonna LOVE your OB rotation as well.

Not sure your set up, but I was blessed with a great partner on my team (each team had two MS3s) - we would divide and conquer. Neither of us would go to the notoriously rough attendings for more than one case in a row - we took turns getting beat. More importantly, dividing the cases makes it so that you can focus your reading...when you know your going into a colon resection, arterial supply of the thyroid should be a bit lower on your list of things to read the night before. In surgery, or any other clerkship, you can also ask shill questions/make statements that sort of "direct" the focus of the conversation toward an area you're more comfortable.

And - find a good pair of shoes. I'm sure I sound like your mom, but it really is worth it. I was a Crocs fan; others like the Frankenfeet look of Danskos. Either way, pleasing your feet makes the standing more tolerable by some biomechanical/sensorineural mystery.

As for the people, you can't control them, and they can't stop the clock. Work hard. You don't have to be a gunner, but do the simple things right. If you present that a pt has diabetes in the PMHx, you should have an idea what the finger stick was.

Good luck.

dc

 

[marie337]

Unfortunately 3rd year is all about doing things that you can't stand. All you can do is find some tiny little thing about the rotation that you enjoy and focus on that or think about a field that you really enjoy and focus on how great it will be to do that rotation. Just think how accomplished you will feel when you get through general surgery in one piece! I absolutely hated most of 3rd year because I hate inpatient medicine. Once I realized that it was just something that I had to deal with to get to where I really wanted to be (psychiatry) I was able to relax a little.

 

[Buckeye(OH)]

Deal with it. I mean I love surgery but I still had to do General IM, cards, OB, peds, and family.

 

[Ashers]

Deal with it. I mean I love surgery but I still had to do General IM, cards, OB, peds, and family.

LOL, same here. add to that list of stuff I still had to do psych and neuro.

 

[vtucci]

I understand. Surgery was trying for me as well (although my issue was physical) and our clerkship director was great and really tried to make it as benign as possible.

Speak to your team. Find something you enjoy doing (or at least do not hate as much). Do you prefer wards? Offer to write the notes, do the consults. Speak to social work, do the discharge paperwork and scripts. Most surgeons seem to hate this and if you can do that kind of scutwork, it is most appreciated by the team and will get you out of the OR if that is what you hate most. Make sure you are seeing enough cases for your clerkship though.

 

[Droopy Snoopy]

Anybody got any tips on how to go about doing this? I can't stand the hours, can't stand standing, can't stand the people, and can't stand being pimped on the minutia of anatomy. HELP!!!

The pimping at least you can definitely prepare for. Surg Recall is good for quick reading, and obviously put in a little effort the night before on regional anatomy if you know what cases are on for the following day. Maybe find a 4th year who knows Dr. so-and-so always asks about this-and-that (they do tend to recycle questions). As mentioned earlier it is possible to direct the conversation into a more teaching/lecturing style vs. pimping, and if you're stuck in the crosshairs you could go to the whole, "well I know it's not this or this because..." which at least shows off what you do know about the case.

Not much you can do about the hours, or the standing, just know that it's a rite of passage and will be over sooner than you imagine. The people may or may not be befriendable, but I've met very few residents or attendings who were utterly malignant through and through.

Watch what happens though when you start getting some pimp questions right. They'll move on to football or stock market talk in the OR and all of a sudden you've got common ground. If at the same time you're making yourself useful on wards and showing some interest/initiative with the material, your relations should improve and they should start letting you do more cool stuff.

 

[phoenix0610]

I understand. Surgery was trying for me as well (although my issue was physical) and our clerkship director was great and really tried to make it as benign as possible.

Speak to your team. Find something you enjoy doing (or at least do not hate as much). Do you prefer wards? Offer to write the notes, do the consults. Speak to social work, do the discharge paperwork and scripts. Most surgeons seem to hate this and if you can do that kind of scutwork, it is most appreciated by the team and will get you out of the OR if that is what you hate most. Make sure you are seeing enough cases for your clerkship though.

I second this post--the way I'm getting through it is by remembering my patients always come first, ignore the BS and the douchebags (easier said than done, I know), work hard and keep my head down--just one more month to go😎

 

[t33sg1rl]

1. Put yourself in the OR with many short cases rather than a few long ones. You'll spend most of your time waiting for the room to turn over.

2. Try to scrub into the same cases over and over. Pimp questions will be the same. "Seeing" a case (ie watching back of resident's head because you don't have a view of the surgical field) in no way prepares you for the shelf exam or teaches you anything at all.

3. Pick laparascopic cases. You will at least get to watch more than the back of someone's head.

4. Hide from the team whenever possible. Out of sight, out of mind.

5. Mentally repeat the mantra "They can hurt you, but they can't stop the clock". Surgeons can be awful, horrible, people, but they only get you for a limited time and no matter how evil they are, that time is ticking down.

p.s. None of these are sarcastic. I really did all of these to make it through surgery. And my grade was very good.

 

[t33sg1rl]

pps I also reported one of my attendings to the hospital's anonymous handwashing noncompliance tip line. I would have done this even if he'd been a nice guy, because MRSA signs meant nothing at all to him, but the fact that he was a total *****hole made the experience more pleasant.

 

[Vaderize]

You must not have been considered a very important part of the team if keeping out of sight helped get you a good grade 🙂.

Seriously, "hiding" is not always a good thing, as it can show up on your eval and hurt you in the future. Be visible, eager but not annoying, work hard, and for goodness sake make sure you take a pre-game dump before a long case 😀.

 

[PeepshowJohnny]

You must not have been considered a very important part of the team if keeping out of sight helped get you a good grade 🙂.

Seriously, "hiding" is not always a good thing, as it can show up on your eval and hurt you in the future. Be visible, eager but not annoying, work hard, and for goodness sake make sure you take a pre-game dump before a long case 😀.

Depends on your school. Here, where your intern/residents evaluation of you typically means less than nothing compared to an attendings AND the shelf score is a big portion of your grade, the "out of sight" method works great.

Basically, you do the rounding in the morning as typical, but in the afternoon you spend most of your time studying for the shelf instead of going to cases. You try to scrub in at least twice per attending (having services with multiple attendings is also crucial) and leave with a good impression. Attendings don't keep track of med students, they just assume their off doing another case and most of the time the resident doesn't either.

You kill the shelf, you get "decent" to "good" evals you get a good grade.

Not the method I've used, but others have with great success.

 

[45408]

You must not have been considered a very important part of the team if keeping out of sight helped get you a good grade 🙂.

Seriously, "hiding" is not always a good thing, as it can show up on your eval and hurt you in the future. Be visible, eager but not annoying, work hard, and for goodness sake make sure you take a pre-game dump before a long case 😀.

On my first month of surgery, I was working with six different surgeons. I would go days or even a week without seeing some of them. They would just assume that I was with someone else. In my case, that was true - I scrubbed into a ton of cases that month - but if I were down in the library napping, they'd never know. The resident wouldn't know either - we were usually not in the same cases, unless there was a really good one going on.

 

[JaSam]

1. Put yourself in the OR with many short cases rather than a few long ones. You'll spend most of your time waiting for the room to turn over.

2. Try to scrub into the same cases over and over. Pimp questions will be the same. "Seeing" a case (ie watching back of resident's head because you don't have a view of the surgical field) in no way prepares you for the shelf exam or teaches you anything at all.

3. Pick laparascopic cases. You will at least get to watch more than the back of someone's head.

4. Hide from the team whenever possible. Out of sight, out of mind.

5. Mentally repeat the mantra "They can hurt you, but they can't stop the clock". Surgeons can be awful, horrible, people, but they only get you for a limited time and no matter how evil they are, that time is ticking down.

p.s. None of these are sarcastic. I really did all of these to make it through surgery. And my grade was very good.

Omg that is amazing advice. Yea I didn't read your post until today, but I've started picking up on most of them. Agree, Agree, Agree 100%.

My biggest pet peeves about surgery are:

1. that its a rotation where yea, you basically stand there staring at the back of some dudes scrubs, or head (depending on height) and have to pretend to look intereested and like your learning a ton. Its an absolute joke. They should figure out that no one gets anything outta that except for maybe more defined calf muscles and tolerance to standing long periods.

2. Rounds don't teach me any medicine at all. Surgery notes and rounds are a joke unlike internal med (which although are excessive actually deal with issues). My residents really don't even care if the patient is alive or not and often joke about how fat or ugly the patient is while they walk to see them. Plus, all it is is basically wound care and crap work. Yea that's why I pay so much money to go to medical school. To check out some dudes ulcer and smell it. Great.

3. Pimping questions are absolutely useless. Like seriously, do I give a F whether or not I know what nerve innervates the omohyoid (sp?)? Or does it really matter that I didn't know that one part of the urethra is called the bulbous urethra? Who gives a crap? Its not like the shelf is gonna ask me this stuff.

 

[smq123]

2. Rounds don't teach me any medicine at all. Surgery notes and rounds are a joke unlike internal med (which although are excessive actually deal with issues). My residents really don't even care if the patient is alive or not and often joke about how fat or ugly the patient is while they walk to see them. Plus, all it is is basically wound care and crap work. Yea that's why I pay so much money to go to medical school. To check out some dudes ulcer and smell it. Great.

😕 First you complain that you didn't learn anything on rounds....but then you also complain that the stuff that they actually WANTED you to learn was "useless," and essentially a waste of your tuition money.

I get that you're not into "wound care and crap work." That's fine. But do you REALLY think that the surgeons dragged you on rounds just to "check out some dudes ulcer and smell it"? How about, you know, learning HOW the surgeons take care of those ulcers?

Learning about wet-to-dry dressings, correct debridement, staging of ulcers, and good antibiotic coverage is very important....EVEN FOR INTERNISTS.

And if surgery rounds took as long as medicine rounds did, you'd never get home until 9 PM. Surgery rounds, just by nature of the field, are devoted mostly to work and utility. Maybe you don't like that, but dismissing them as a "joke" is cavalier and shows that you're not really doing your best to learn much on this rotation....

3. Pimping questions are absolutely useless. Like seriously, do I give a F whether or not I know what nerve innervates the omohyoid (sp?)? Or does it really matter that I didn't know that one part of the urethra is called the bulbous urethra? Who gives a crap? Its not like the shelf is gonna ask me this stuff.

Uh....the H&N surgeon gives a crap. And the urologist.

Look, you might not like the field of surgery. Fine, that's not a problem at all. But I honestly think that it is YOUR responsibility to, at the very least, learn what is important to surgeons so that when you DO consult one when you are an internist/pediatrician/psychiatrist/etc, you know WHAT information will ultimately matter in your conversation.

In any case - if you don't know that, for instance, one part of the urethra is called the bulbous urethra, I would wager that you're not doing a lot of reading. If you're not reading, then there's no way that you can enjoy the surgery rotation because you won't know what is going on.

 

[SoCuteMD]

😕 First you complain that you didn't learn anything on rounds....but then you also complain that the stuff that they actually WANTED you to learn was "useless," and essentially a waste of your tuition money.

I get that you're not into "wound care and crap work." That's fine. But do you REALLY think that the surgeons dragged you on rounds just to "check out some dudes ulcer and smell it"? How about, you know, learning HOW the surgeons take care of those ulcers?

Learning about wet-to-dry dressings, correct debridement, staging of ulcers, and good antibiotic coverage is very important....EVEN FOR INTERNISTS.

And if surgery rounds took as long as medicine rounds did, you'd never get home until 9 PM. Surgery rounds, just by nature of the field, are devoted mostly to work and utility. Maybe you don't like that, but dismissing them as a "joke" is cavalier and shows that you're not really doing your best to learn much on this rotation....



Uh....the H&N surgeon gives a crap. And the urologist.

Look, you might not like the field of surgery. Fine, that's not a problem at all. But I honestly think that it is YOUR responsibility to, at the very least, learn what is important to surgeons so that when you DO consult one when you are an internist/pediatrician/psychiatrist/etc, you know WHAT information will ultimately matter in your conversation.

In any case - if you don't know that, for instance, one part of the urethra is called the bulbous urethra, I would wager that you're not doing a lot of reading. If you're not reading, then there's no way that you can enjoy the surgery rotation because you won't know what is going on.

can't say I remember the "bulbous urethra"coming up at all during my surgery reading - and my attendings universally commented on my diligence in that department. As far as calling surgery consults, I've never had a surgeon actually care about what I had to say when I tried to call them.

To the OP - sorry you are dealing with this. Surgery sucked for me too, and I agree with the sentiment someone expressed above, "They can hurt you, but they can't stop the clock."

To whomever commented about surgery rounds - I think this varies from chief to chief. I had one chief who was great with patients (totally different story as a colleague) and another chief who didn't give a s--- about anything other than a) scrubbing into as many surgeries as possible and b) hitting on all the young, pretty nurses.

 

[smq123]

can't say I remember the "bulbous urethra"coming up at all during my surgery reading - and my attendings universally commented on my diligence in that department. As far as calling surgery consults, I've never had a surgeon actually care about what I had to say when I tried to call them.

- If you are reading for a case that is deep in the pelvis, then the urinary tract anatomy is likely to come up.

I agree, if you spend your entire time on a CT service, then the bulbous urethra is not likely to come up. But, since the surgeon asked about it, it was most likely because it was somehow related to the case at hand. If it wasn't, then my apologies to the OP.

- You're a med student. The surgeons probably DON'T care what you say when you call in consults, because they're assuming that, as a med student, you don't know anything.

But when calling in a surgery consult as a resident - they usually appreciate more information.

My point is - you may hate the rotation. You may hate the field. But there are definitely points that can be taken away from every rotation, no matter what your field of interest may be.

 

[SoCuteMD]

- If you are reading for a case that is deep in the pelvis, then the urinary tract anatomy is likely to come up.

I agree, if you spend your entire time on a CT service, then the bulbous urethra is not likely to come up. But, since the surgeon asked about it, it was most likely because it was somehow related to the case at hand. If it wasn't, then my apologies to the OP.

- You're a med student. The surgeons probably DON'T care what you say when you call in consults, because they're assuming that, as a med student, you don't know anything.

But when calling in a surgery consult as a resident - they usually appreciate more information.

My point is - you may hate the rotation. You may hate the field. But there are definitely points that can be taken away from every rotation, no matter what your field of interest may be.

No, they really don't care anyways. I've seen plenty of residents call surgery consults, they got the same response I did. I don't take it personally, and I understand that surgeons approach things much differently than I do.

And it's silly to assume that a resident could do a better job providing surgeon with the "right" information whereas a med student can't. Med students are much closer to their core clerkship than residents are. When there's a question about another field, it's often been my experience that the team may ask the med student for their input based on their clerkship in that field.

 

[JaSam]

No, they really don't care anyways. I've seen plenty of residents call surgery consults, they got the same response I did. I don't take it personally, and I understand that surgeons approach things much differently than I do.

And it's silly to assume that a resident could do a better job providing surgeon with the "right" information whereas a med student can't. Med students are much closer to their core clerkship than residents are. When there's a question about another field, it's often been my experience that the team may ask the med student for their input based on their clerkship in that field.

I second that. I've never seen the surgical res take consults and believe what the resident,med student, whatever has said. In fact while walking over to see our consults my chief res is making fun of how stupid the person who consulted him is time after time. Yea right, the hell they give a crap what residents say. They think they're surgeons and know everything and other people don't know jack.

 

[smq123]

No, they really don't care anyways. I've seen plenty of residents call surgery consults, they got the same response I did. I don't take it personally, and I understand that surgeons approach things much differently than I do.

And it's silly to assume that a resident could do a better job providing surgeon with the "right" information whereas a med student can't. Med students are much closer to their core clerkship than residents are. When there's a question about another field, it's often been my experience that the team may ask the med student for their input based on their clerkship in that field.

I second that. I've never seen the surgical res take consults and believe what the resident,med student, whatever has said. In fact while walking over to see our consults my chief res is making fun of how stupid the person who consulted him is time after time. Yea right, the hell they give a crap what residents say. They think they're surgeons and know everything and other people don't know jack.

Everyone's experience is different. My experience has been that residents do NOT defer to my "input" based on my clerkship. I was still told to consult gen surg for "STAT Whipples" (no such things as stat Whipples) or urology for "STAT ureter stone removal" for a patient that was not in a lot of pain, wasn't septic, wasn't even moderately ill-looking, and had a creatinine of 1.1. Any attempt to explain why these were kind of crappy consults were firmly ignored.

AND my experience has been that the more info you provide in your consult, the better the interaction between you and the consultant will be. And the best way to know what kind of info to provide is to have some idea of what your consultant is looking for.

But whatever. You seem firmly convinced that your surgery rotation is useless and a waste - a reaction that seems based mostly on emotion than logic. So trying to convince you otherwise with logical arguments is not going to work.

 

[SoCuteMD]

Everyone's experience is different. My experience has been that residents do NOT defer to my "input" based on my clerkship. I was still told to consult gen surg for "STAT Whipples" (no such things as stat Whipples) or urology for "STAT ureter stone removal" for a patient that was not in a lot of pain, wasn't septic, wasn't even moderately ill-looking, and had a creatinine of 1.1. Any attempt to explain why these were kind of crappy consults were firmly ignored.

AND my experience has been that the more info you provide in your consult, the better the interaction between you and the consultant will be. And the best way to know what kind of info to provide is to have some idea of what your consultant is looking for.

But whatever. You seem firmly convinced that your surgery rotation is useless and a waste - a reaction that seems based mostly on emotion than logic. So trying to convince you otherwise with logical arguments is not going to work.

I am not the OP, and I certainly did not say that my surgery rotation was a waste, so please don't put words into my mouth.

You may never have had an attending or resident ask your opinion/understanding of a topic and take it into account, but it's been a fairly frequent occurrence for me especially this year. One attending asked me about managing MRSA, as he had trained before CA-MRSA was a big thing. Some of my attendings in pediatrics have asked me questions about adult medicine since they haven't seen adult patients in a number of years. Sometimes they do it to quiz me, and sometimes they do it because they genuinely don't remember and would like my input. If i don't know, I say so, and make an effort to find out and initiate a discussion about it.

 

[smq123]

I am not the OP, and I certainly did not say that my surgery rotation was a waste, so please don't put words into my mouth.

That wasn't directed at you, actually.

You may never have had an attending or resident ask your opinion/understanding of a topic and take it into account, but it's been a fairly frequent occurrence for me especially this year.

Fantastic for you. It hasn't been as big an occurrence for me. I DID say that everyone's experience was different.

One attending asked me about managing MRSA, as he had trained before CA-MRSA was a big thing. Some of my attendings in pediatrics have asked me questions about adult medicine since they haven't seen adult patients in a number of years.

You're basically strengthening my point.

It would be an advantage for the OP to learn as much about surgery as he reasonably can (and not dismiss learning opportunities as "disgusting" and a "waste of time"), so that he can help out his teams later on in his MS3 year, into MS4. And then he can carry that experience on into residency.

I mean, I didn't love talking to heroin addicts....but it DID come in handy later on in my OB rotations, where I was very comfortable talking about methadone and withdrawal symptoms with patients. I REALLY hated trauma surgery, but it came in handy later when I did my IM rotation, because I knew the right stuff to say when calling in a consult, so that things would get done faster. Plus, trauma did teach me a little bit about good stoma and ostomy care, which came in handy again for IM and FM.

The point is - you may hate the rotation for any number of reasons. But you can't dismiss the learning opportunities that that rotation gives you. Furthermore, as an MS3, you just don't know enough to TRULY say what is "useful" to know and what is not. And, based on what you're saying, it seems that you'd agree....

 

[SoCuteMD]

That wasn't directed at you, actually.



Fantastic for you. It hasn't been as big an occurrence for me. I DID say that everyone's experience was different.



You're basically strengthening my point.

It would be an advantage for the OP to learn as much about surgery as he reasonably can (and not dismiss learning opportunities as "disgusting" and a "waste of time"), so that he can help out his teams later on in his MS3 year, into MS4. And then he can carry that experience on into residency.

I mean, I didn't love talking to heroin addicts....but it DID come in handy later on in my OB rotations, where I was very comfortable talking about methadone and withdrawal symptoms with patients. I REALLY hated trauma surgery, but it came in handy later when I did my IM rotation, because I knew the right stuff to say when calling in a consult, so that things would get done faster. Plus, trauma did teach me a little bit about good stoma and ostomy care, which came in handy again for IM and FM.

The point is - you may hate the rotation for any number of reasons. But you can't dismiss the learning opportunities that that rotation gives you. Furthermore, as an MS3, you just don't know enough to TRULY say what is "useful" to know and what is not. And, based on what you're saying, it seems that you'd agree....

I'm just a little confused by what you are saying. According to my understanding, one of the purposes of a core clerkship in surgery is to learn enough about surgery to facilitate useful communication with surgeons during the rest of your career. According to you, however, the reason surgeons don't care about what I have to say when I call them (literally they interrupt me as soon as I say, "There is a patient we'd like you to see to help us r/o high grade SBO" with "name, room number, thanks, bye") is because as an MS4 I HAVEN'T LEARNED ENOUGH ABOUT SURGERY to provide useful information to surgeons. Since, as MS4s, most non-surgeons have had about as much surgery training as they will ever get - when (and where) are they supposed to acquire these useful communication skills?

 

[smq123]

I'm just a little confused by what you are saying. According to my understanding, one of the purposes of a core clerkship in surgery is to learn enough about surgery to facilitate useful communication with surgeons during the rest of your career. According to you, however, the reason surgeons don't care about what I have to say when I call them (literally they interrupt me as soon as I say, "There is a patient we'd like you to see to help us r/o high grade SBO" with "name, room number, thanks, bye") is because as an MS4 I HAVEN'T LEARNED ENOUGH ABOUT SURGERY to provide useful information to surgeons. Since, as MS4s, most non-surgeons have had about as much surgery training as they will ever get - when (and where) are they supposed to acquire these useful communication skills?

😕

I'm not sure what wires got crossed where....

My point to the OP was that, if he passes up the opportunity to learn as much as he can on this rotation, he is passing up the opportunity to be a more effective physician in the future.

A lot of med students that surgeons are forced to talk to, as well as many non-surgeon residents, often do not seem to have learned what kind of things matter to surgeons, and this makes the consultation a painful experience for everyone involved. If the OP doesn't make the effort to really learn a lot from his surgery rotation, he's likely to become one of these residents.

My points had NOTHING to do with you - I'm sure you worked hard on your surgery rotation and did your best to learn a lot. I'm not sure why you're taking this so personally.

I think that a lot of surgical residents assume that all med students have blown off their surgery rotations, haven't really learned the most basic things of how to workup a surgical problems, and so they tend to dismiss anything that comes out of the med student's mouth. I like to surprise them when this happens. 😀 No reason why the OP can't surprise them, too.

Maybe this is something that I have learned from surgeons? Because I'm evidently not the only person to think like this:

i mostly bring this up b.c the point of thrid year rotations is to make you aware ofwhat the specialitities do, even if you dont go into that speciality. To do that you have to participate, get entrinched, work hard. The standards start at the top, the program has to set the standard for what is expected.

I hate getting consults from people who have no idea how to take the first step in a gen surg workup.

I see, CAT scans for cholcystitis, stat consults for reducible hernias, people waiting 3 days on nec fasc (by which time the pt is almost dead)

Without peoples surgery rotation, they dont understand crap about taking care of realy sick people or the first thing about reading film, ect

 

[nope80]

Can somebody please clarify, it seems as though there is a lot of freedom on these rotations like with surgeons assuming if you aren't with them, you are in another case - how does this work? I thought that you would always be assigned to scrub into certain surgeries? Is this not the case? Can someone give me a basic introduction into what a typical day is on a surgery rotation? and what the flexibility is like? I appreciate it🙂

 

[dragonfly99]

You are correct. If you don't advocate for yourself, you could get lost in the shuffle on many surgical rotations...at least that was my experience during 3rd year.

My advice is talk to students who are your friends who already did surgery rotation at your school...find out who are the good attendings and senior residents to work with and deal with, and try to find a way to get to work with them. If you can't, at least you might be forewarned about who are the hardest folks to deal with.

Try not to get lost in the shuffle either during rounds or after rounds. Stick close to your team, particularly the senior resident(s) who will likely be scrubbing in on cases with the attendings. Smile a lot at the attendings and senior residents. Always get there on time - earlier is better. Help the intern(s) do stuff but realize that it won't be enough to do much of anything for your grade...you need face time with attendings. Try making out a small index card with your name, cell phone number and pager number on it (plus perhaps the days/times you have required med student lecture(s) and will be gone), and give it to the senior resident(s) so they can contact you if they need you.

It's a good idea to carry a small scissors with you, and some of that white tape they use to fasten bandages, etc. That way you can be helpful.

Offer to attend the attendings' "clinics" so they get to know your name. Ask the senior resident on the service if he/she can help you look at the schedule of surgeries for the week and find some that you could plan to scrub in on. That way you can study up on the anatomy and surgical procedure BEFORE you are in the room with the attending pimping you.

 

[PeepshowJohnny]

Can someone give me a basic introduction into what a typical day is on a surgery rotation? and what the flexibility is like? I appreciate it🙂

Now this is incredibly variable based on your institution, attending/resident preferences, clerkship director's preferences, etc. But here's a "typical" surgery rotation set up, which was quite similar to mine.

Students are expected to arrive quite early, typically earlier than the interns, and preround and write notes on their patients. You typically are much less in depth than a medicine rotation, but may be asked to actually do more such as changing a dressing etc.

Once prerounding is done, you may run the list with the senior residents and other intern and students to address any pressing issues, make sure everyone is seen.

As for rounding with the attendings, I've seen lots of different styles. Sometimes one attending representing a team or subspecialty rounds on al the patients for different days, sometimes you round with individual attendings at set times. Sometimes you round before any surgeries, sometimes you may only see the most critical patients, perform the first case, then finish up. This can change from institution and even day to day. Rounds in surgery is much more focused on getting work done and into the OR, where the majority of the teaching is done, compared to medicine. Unless you have very formalized rounds with the attendings (which you may have on certain days of the week) it's not really a great idea to approach them like medicine rounds and prepare little presentations or pull articles.

After some degree of rounding is complete, you are free to go to the OR. In our institution it is advised you stay with your assigned team to prevent six med students from trying to see the same case, but we were free to step outside the bounds on occassion if you needed to see a certain case for a clerkship requirement. IE you're on peds surgery, you've seen a ton of orchiopexies and you really need to see a breast or vascular case so you go to them.

Anyway, you typically have freedom in your own team on what you want to see, depending on how many cases are being done that day. It's typically up to you to pick the cases you want to go to that will be the most educational and decrease your downtime. Your residents will typically help you pick good cases to go to if you ask them, but I was never really given unsolicited advise on what I HAD to go to.

When the inevitable downtime does occur, you typically coordinate with your resident/intern to see if they'd prefer you help with floor work or go to independent study or whatever. Once again, individual resident specific.

You'll often have scheduled didactics that may or may not be mandatory sprinkled in, so that's another scheduling hassle.

You're typically free to leave when the day's work is done: there are no cases scheduled, all the floor work has been done, patients seen, consults called, results followed up, check out given to the on call team. Or your resident may send you early depending on their preference, but be careful of how this is phrased and what you hear about personalities as this may be generosity or a test.

eg "The only case left is an add on lap chole starting in a bit. But you know, I'm going to be assisting and you've seen a lot of them, you can take off if you want" is probably the resident being generous, but be careful. However you will be looked down on almost across the board if you elect to leave and miss an interesting/rare case/condition OR pass on any opportunity to be an active participant in the case.

Call is also highly variable so I won't even go into it.

 

[Doctor Bagel]

Can somebody please clarify, it seems as though there is a lot of freedom on these rotations like with surgeons assuming if you aren't with them, you are in another case - how does this work? I thought that you would always be assigned to scrub into certain surgeries? Is this not the case? Can someone give me a basic introduction into what a typical day is on a surgery rotation? and what the flexibility is like? I appreciate it🙂

I'm curious about this, too. I've heard it's possible at my school to avoid scrubbing in on certain surgeries and to not scrub in very much if you're not interested. I'm wondering how to play that without seeming like a total slacker.

 

[smq123]

I'm curious about this, too. I've heard it's possible at my school to avoid scrubbing in on certain surgeries and to not scrub in very much if you're not interested. I'm wondering how to play that without seeming like a total slacker.

You're probably better off asking people at your school. Each school, and each rotation site, conduct things differently.

 

[meister]

People at my school have suggested doing the surgical rotation at the VA hospital. Apparently it's 10x less stressful than the university hospital.

 

[Trail Boss]

I think a good way to survive surgery, or any rotation is to be without personality, without opinion and without the need for sleep. Work hard, keep your head down state only the facts, precisely and concisely. Never got dinged for that.

 

[themudphud]

Try memorizing some lines from the movie "Top Gun". They love that stuff.
The surgery clerkship is not supposed to be easy--it's supposed to teach you about surgery and give you an idea what a surgical career may be like. At least you know you're not a surgery person... 🙂

 

[45408]

I think a good way to survive surgery, or any rotation is to be without personality, without opinion and without the need for sleep. Work hard, keep your head down state only the facts, precisely and concisely. Never got dinged for that.

It's also a great way to come off as boring and to have a boring rotation. My attending and I were quoting Chappelle Show in the OR. Much more entertaining.

Without opinion? So what are you going to say when they ask "What should we do?" I got asked that at least a dozen times on rounds, and if my suggestion seemed reasonable, the attending would just say, "Okay, let's do it." Virtually all of clinical medicine has an element of opinion in it.

 

[Trail Boss]

I guess I don't think of "What should we do" as an opinion question, maybe I didn't articulate that very well. I guess I was more trying to say "don't mouth off and don't complain"

 

[45408]

I guess I don't think of "What should we do" as an opinion question, maybe I didn't articulate that very well. I guess I was more trying to say "don't mouth off and don't complain"

I agree wholeheartedly with that suggestion, but it's pretty different from your other suggestion.