Saturday, September 27, 2008

Tips for Doing Well in the Surgery Rotation

I think a lot of people are pretty intimidated by surgery, especially if you don't see yourself as the surgery type. But honestly, surgery is a lot of fun if you work hard and make an effort to learn how to be useful in the OR. Here are my tips for getting more out of your OR experience. Some are only applicable to Case students, but most are applicable to any med students.

1) Learn how to tie knots. I had a terrific attending who let me do a lot in the OR, and she let me do even more once she realized that I had learned how to tie knots. It was terrific. The best thing to do is to get one of the residents to show you and then practice on your own. You can probably get a few suture kits from the OR and use those to practice. Once you get the hang of it, practice using gloves. It's a lot harder tying knots with gloves on because the gloves are kind of slippery, and you can't feel the sutures as well.

2) Be assertive. Surgery is not going to be as much fun if you are more the quiet wallflower type. You have to tell residents and attendings that you want to scrub, suture, etc. and not wait around hoping for them to notice you. I don't consider myself to be particularly quiet, but my attending thought I was anyway because I'm not as forceful as she is. No other preceptor I've ever worked with has said that I need to be more aggressive. I really think it's a surgery thing!

3) Don't take being yelled at personally. It's not just you. Surgeons are tired, overworked, and a bit obsessive compulsive. They love efficiency, and third year med students are the wrench in their works. We're all a little clumsy, so we all get yelled at.

4) Don't fight with scrub nurses. No exceptions on that one. Just don't do it. You've already lost with the very first word out of your mouth. If a scrub nurse tells you that you've contaminated yourself, apologize and ask them what they want you to do. If they tell you to re-scrub, re-gown, and re-glove, do it without arguing. If you don't fight them, they won't make your life nearly as miserable. I had to change a few gloves and gowns, but I never had to re-scrub from scratch.

5) Try to read for half an hour every day. Surgery is one of those rotations that is more a 5-to-9 job than a 9-to-5 job. But you still need to read about your patients, log them, and complete your learning objectives. If you keep up with this regularly, you won't be swamped and panicky at the end of the rotation. I liked the NMS Surgery Casebook and did not use the Lawrence book that was recommended for the rotation at all. I also liked Cope's Early Diagnosis of the Acute Abdomen, which was one of the recommended supplements for the rotation. It's kind of quaintly written, but it's also written in a conversational style. Since most of us were on gen surg or colorectal teams, understanding indications for abdominal surgery is pretty important.

6) Don't be a martyr when preparing for the oral exam. When I first started the rotation, I wanted to prepare for all of the questions by myself. I quickly realized it would be impossible. There just aren't enough hours in a day when you're on surgery. Things went much better after I split the work up with one of the other students on the rotation with me.

7) Try to read about the surgeries before you scrub, including the anatomy you are going to see. This is good for two reasons: one, you will get more out of the surgery if you know what is going on, and two, you will be more prepared if you get pimped. I at least tried to read the appropriate chapter of Surgical Recall before scrubbing for my subspecialty surgeries. For those of you who are at CCF and don't want to buy your own copy, they have one in the library. I checked it out instead of buying it since I was pretty sure I wouldn't be going into surgery.

8) Eat breakfast every morning, especially on OR days. A lot of people try to eek out those last few minutes of sleep and skip breakfast. It's a bad idea. Really. Your chances of passing out will be seriously higher if you skip breakfast. Don't forget that if you're scrubbed in all day, you probably won't be eating lunch, and there's a very real chance you won't be eating dinner, either.

9) Make sure you keep tabs on your patients and know what's going on with them. Check their labs every day and pay attention to anything that is irregular. When you write up your notes, make suggestions for what you think might be wrong and what you think should be done about it. You'll be wrong at least half the time, but it's better to try to figure it out and be wrong than to not try and just look uninterested.

10) Don't despair when the going gets tough. Surgery is physically and mentally difficult, but it's doable. Thousands of other med students have made it though this rotation, and you will, too.


ddrullinsky said...

Excelent post. I'm a med student from Chile, doing my internsip. Currently i'm in Montreal doing an elective rotation con cardiac surgery and everything you said applies perfectly here or back home! Thanks!

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