while observing a procedure...

[goodies]

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while scrubbed in observing a surgery and retracting, do you recommend asking the residents and attending questions about what they are doing... ie. "is that the cardinal ligament that you are clamping?" or is it better to just answer if/when pimped? i have a hard time figuring out whether or not to "show off" what i know versus keeping quiet so they don't get annoyed. what's the best thing to do???

 

[Kubed]

Ask questions if you are curious or unsure of something. If you ask questions to show off, they can smell it from a mile away...

 

[jdh71]

while scrubbed in observing a surgery and retracting, do you recommend asking the residents and attending questions about what they are doing... ie. "is that the cardinal ligament that you are clamping?" or is it better to just answer if/when pimped? i have a hard time figuring out whether or not to "show off" what i know versus keeping quiet so they don't get annoyed. what's the best thing to do???

That is, unfortunately, attending specific - some attendings, especially if they trained on the east coast, don't want to hear you say a thing, unless they ask. Also, if they are in the middle of the toughest part of the procedure, don't start chatting . . . One last thing . . . you've heard the saying, "there is no such thing as a dumb question," well, not so on the surgery service. Anything you can easily look up, basically, anything you can find in essentials of surgery, is a "stupid question" and will make you look like a tool. Ask, "good" questions if you do.

So . . . in the end, remembering the above rules, ask away and if you get handed your a$$, remember not to.

 

[Blade28]

Agreed - ask intelligent questions. Never try to "show off" (in any rotation) - you don't think the residents, fellows and attendings know what you're trying to do?

 

[Top Gun]

while scrubbed in observing a surgery and retracting, do you recommend asking the residents and attending questions about what they are doing... ie. "is that the cardinal ligament that you are clamping?" or is it better to just answer if/when pimped? i have a hard time figuring out whether or not to "show off" what i know versus keeping quiet so they don't get annoyed. what's the best thing to do???

Also, some surgeons don't like it when you ask questions about anatomy. They will say you should have learned it in first year. These surgeons prefer questions regarding diagnosis and management.

 

[goodies]

what if they already started out asking questions... ie. what layers are we cutting through... ie. what artery is this...

and i answered all of those.. but what if i want to answer more? for them to ask/pimp me anatomy questions, that means they would be okay with me asking them anatomy questions, no?

 

[PeepshowJohnny]

what if they already started out asking questions... ie. what layers are we cutting through... ie. what artery is this...

and i answered all of those.. but what if i want to answer more? for them to ask/pimp me anatomy questions, that means they would be okay with me asking them anatomy questions, no?

Once again, surgeon specific.

Some are going to be impressed with your dedication and be happy to discuss anatomy with you.

Some are going to be annoyed and label you incompetent or a brown noser. Gotta feel it out.

 

[RockShox]

The easiest way to deal with this is just to ask ahead of time. So before the procedure is going to happen when you introduce yourself to the attending say..

"Thank you Dr. So and So for letting me participate. I know I will have a number of questions would you prefer i ask after the procedure is finished or as we are going?"

You can also ask the residents who know the personality of the person.

Then be GOOD at observation. Meaning if the case is going south keep your trap shut.

And for the love of God! Don't just ask a question because you feel you need to ask a question. Almost everytime it is a dumb, irrelevant question that makes you look like an goof. Instead of "Is that the common bile duct" Ask "Tell me about some of the techniques that you have found useful to consistently identify the common bile duct and prevent ligation?" It is open ended, shows that you know some common issues related to the procedure, and envokes a response that brings you up to resident-level knowledge, not to mention you stroke the ego.

 

[Winged Scapula]

If the residents like you they may "feed" you the questions Attending X usually asks (because we tend to ask the same ones over and over again).

So you may inquire of the residents what Dr. X likes and if there is anything in particular you should read up on/know about.

 

[Hard24Get]

Also, some surgeons don't like it when you ask questions about anatomy. They will say you should have learned it in first year. These surgeons prefer questions regarding diagnosis and management.

Sometimes you have to ask, like during laparascopies when you are getting used to the camera, you need to verify what things are to get oriented (given the attending has started chatting away first, of course). Afterall, we never played human anatomy videogames in the first year of medical school.

We should have, but we didn't 😉

 

[Top Gun]

Sometimes you have to ask, like during laparascopies when you are getting used to the camera, you need to verify what things are to get oriented (given the attending has started chatting away first, of course). Afterall, we never played human anatomy videogames in the first year of medical school.

We should have, but we didn't 😉

You may have to ask, on occasion. But if its your first laparoscopy, a good resident or attending will take the time to orient you when the camera is inserted.

 

[Top Gun]

what if they already started out asking questions... ie. what layers are we cutting through... ie. what artery is this...

and i answered all of those.. but what if i want to answer more? for them to ask/pimp me anatomy questions, that means they would be okay with me asking them anatomy questions, no?

By all means, answer whatever anatomy questions surgeons throw at you. And if you want to answer more questions, you'll have plenty of chances. Your surgery rotation will be at least a few months long, and you will scrub with many surgeons. Each of them will have their own way of pimping you.

 

[jocg27]

You may have to ask, on occasion. But if its your first laparoscopy, a good resident or attending will take the time to orient you when the camera is inserted.

That must be interesting.

During my two month surgery rotation I was really never oriented to much of anything, least of all the laparoscope.

 

[Miler407]

During Surgery rotation, are most surgeries known ahead of time, so that the day before we can read up on the procedure and review anatomy involved? Or do we just not have time to study that in depth b/c we're hella busy during surgery rotation? I'm just starting MS2, so I apologize for being naive.

 

[Blade28]

The OR schedule is usually posted the day before (often after 12 pm). However, sometimes the residents leave it up to you and the other MS-IIIs to decide who's scrubbing into which case...and sometimes they assign the cases on the morning of. Tough situation.

But in general, you can always read up for all of the following day's cases. You should be reading about the basic disease processes anyway - gallstones, appendicitis, colon cancer, acid reflux, breast cancer, thyroid cancer, etc.

And good basic information to know about each patient (can be obtained by skimming their H&P in 5 minutes) is indication for surgery, any significant past medical history, and important pre-op labs (e.g. H&H if low, platelet count, K, creatinine, coags, relevant imaging).

Good stuff to know for the case includes indications, relevant anatomy, and possible complications.

 

[46&2]

For your med school rotations, Surgical Recall is the bare minimum you should know for basic knowledge, along with scanning the chart as Blade suggests. It's also about the maximum you can practically do if you're working hard and reading on other important subjects for the shelf. It takes 10-15 minutes to get through a Recall chapter. There's usually enough downtime before the OR where you can meet the patient, peek at the H&P, and scan Recall.

If you're really interested in surgery, then reading the appropriate chapters of a book like Khatri's Operative Surgery Manual or ACS can really add to your understanding of the case.

While the operative schedule is known at least a day beforehand, stuff always happens so a case is delayed, another goes before it, another student takes it, etc. I rarely went to the operation I planned to observe.

 

[Blade28]

I also highly recommend carrying around Surgical Recall at all times during your MS-III surgery rotation (but I'm biased, since I'm one of the contributors 🙂 ).