HealthJune 25, 2015

10 tips for making the most of your surgery clerkship

No matter what field you want to go into, you have to complete a surgery rotation. And it can be the most painful experience of your life, or you can learn from it. So no matter your future career, it’s worth making the best of it. It will be more tolerable, even enjoyable, and you’ll learn more.

With that in mind, I will spare you a pep talk and simply list ten helpful tips I learned along the way. Also attached is a vitals sheet and a cheat sheet I made. If you print the cheat sheet as four sheets to a page, you can fold into quarters and stuff in your top front white coat pocket for quick reference. Go ahead and add other quick reference items.

  1. Consider surgery as a career. Even if you already know what you want to do, force yourself to consider it. This will make you more interested and motivated. The alternative is to fake like you’re interested, which is bound to fail.
  2. Work on Lombardi time. Show up 15 minutes early to everything. Whether that’s pre-rounds, rounds, grand rounds. Always be early. This is important for all clerkships, but most important for surgery.
  3. Stuff your pockets. Show up the first day with the essentials: tape, 4x4s, bandage scissors, and cotton-tipped applicators. But ask your intern/resident what type of supplies is best. There are a number of different types of tape and each senior resident and attending likes a different one for different situations. Also be present and observant during rounds when changing dressings. Ask yourself, “what is being used most often?” Those are the items you should have handy at all times. And don’t worry we all looked like fools with stuffed-to-the-brim white coats.
  4. Don’t make the same mistake twice. If you forget to look at a patient’s wound, don’t forget again. If you forgot to follow-up on a lab value, next time remember. This also applies to the OR, but for some attendings and residents, med students are seemingly always making mistakes. Just try your best to improve each day and you can’t fault yourself.
  5. Always be looking for ways to make things more efficient. Whether that’s using the attached vitals sheet or getting a surgical instrument in the OR, constantly be looking for simple ways to improve the efficiency of the team. The quicker things get done the sooner you can go home, or get to the OR.
  6. Read up on the surgeries the night before. Figure out the next day’s surgical schedule. Ask your intern or resident. Or go to the OR scheduling desk. Or check out the schedule online using the EMR. Focus on the anatomy, indications, and complications. The attendings and residents are not expecting you to know the surgical techniques. In addition, techniques are very rarely tested on the surgery shelf.
  7. Practice knot tying early and often. Being proficient and confident (not cocky) with your knot tying can really earn med students praise from their superiors. Go find some string and watch YouTube videos of how to throw two-hand and one-handed hand ties and instrument ties. Ideally you should be able to throw with both hands.
  8. Always bring an issue up with your direct superior. That may be the sub-intern, intern, or 2nd year resident. Don’t bring up a low serum potassium during attending rounds. No one will be happy including the attending. Bring this type of stuff up with your direct superior, usually the intern.
  9. Think before asking a question. First ask yourself, “is this the right time?” Second, “can I easily look this up?” Attendings and residents don’t appreciate untimely questions that could be easily looked up. They show a lack of awareness and laziness.
  10. Slow is smooth, smooth is fast. If lucky, you will have the opportunity actively participate- meaning do more than retract. Whether you’re throwing stitches or driving the laparoscopic camera, go slow and smooth. Quick, jerky movements have the potential of getting you in trouble.

Before I finish up here, I’d like to offer you all a couple cheat sheets that you may find helpful during a surgery clerkship: post-op cheat sheet and vitals cheat sheet. Feel free to print them out, fold them up, and add them to your “stuff your pockets” list.