Monday, May 20, 2013

Welcome to the New AWS Blog & Tips for Surviving Your Surgery Clerkship

We're proud to share the launch of the AWS blog with you, and hope that this will provide a new resource for you. We'll be posting at least once a week, trying to spark a conversation with you--usually about a topic that relates directly to being a woman surgeon, but also about things that relate to life in the modern day. Mostly, we do want this to be a place for conversation, for thought, for discussion, and we look forward to getting to know you better through that dialogue. If you have a topic of interest you would like to see us address, please let us know. Those of us writing for the blog and the leadership of the AWS are interested in creating a community space, and to do that, we need to hear your voice.

Welcome!

Amalia Cochran, MD, FACS, FCCM
Secretary, Association of Women Surgeons


Surviving Your Surgery Clerkship

by Lauren B. Nosanov

I was asked to help compile some words of advice for students entering their third year of medical school, specifically addressing tips for surviving the surgery clerkship. Surgery was my first rotation of my third year, and by far my favorite. That said, I know that many students do not enjoy it nearly as much, and experience a great deal of anxiety thinking about it. As such, I have decided to share here those pointers which I thought would be universally applicable.

General Pointers
  • Be excited about the OR! 
    • Surgeons love the OR and they want you to also, even though they accept that most rotating students will not end up applying to a surgical field. Don't shirk your duties outside of the OR, but do your best to spend as much time observing and participating in operations as you can. 
  • Learn the basics of the OR: 
    • how to scrub (you will be taught this at the beginning of the clerkship - pay attention, sterile technique is important!) 
    • how to not accidentally scrub yourself out (few things raise the ire of an attending / resident as much as a med student who scratches their nose and then contaminates the surgical field!) 
    • what is sterile in the OR and therefore should be avoided when not scrubbed (pretty much everything draped in blue is a good rule of thumb) 
    • where to stand and observe to have a good view but not be in the way (when in doubt, ask) 
  • Anatomy, anatomy, anatomy. 
    • This is 90% of what you will be pimped on, and good knowledge of relevant anatomy makes it much easier to figure out what is going on in the OR. Go back and review the relevant parts of your notes from first and second year lectures and labs. Make sure you know what cases your team will be doing if at all possible and study up the night before. 
  • Learn to tie and to suture ASAP. 
  • Students who can demonstrate these abilities are more likely to be allowed to do things in the OR other than retract. Take advantage of the surgical skill center and the amazing people who work there and practice, practice, practice. 
  • Be confident. 
  • Surgeons tend to be straightforward and sometimes even a bit impatient. When you present, speak up, speak clearly and most importantly, speak concisely. This will earn you respect, and in turn you are more likely to receive more teaching, more opportunities to see and do cool procedures, and (of course) a better grade. 
  • Help your team by becoming a walking cabinet - you will be thanked endlessly time saved and hassle avoided. At a minimum, consider carrying (in white coat pockets or a bag): 
    • radiology order forms 
    • sliding scale forms 
    • trauma forms 
    • suture removal kits 
    • staplers 
    • suture 
    • sterile gloves in your size and your resident's size 
    • sterile saline 
    • syringes 
    • marking pens 
    • kerlix 
    • 4x4s 
    • tape 
    • extra copies of the team's patient list 
  • Be gracious when you are allowed to close at the end of a case. This educational opportunity comes at a cost to everyone else (mostly in the form of time, as you are inevitably slower than your resident closing or stapling). Your appreciation to the OR support staff and your residents will not go unnoticed, and you will likely find that you are given opportunities to close more often. 
  • When on call, don't forget to pack: 
    • lots of healthy snacks you can carry in your white coat pocket (think string cheese, ziplocs with nuts, granola bars, bananas, PBJ) - eat when you can to keep your energy up! 
    • deodorant, toothbrush and toothpaste, washcloth, extra glasses / contact lenses - anything that will help you stay feeling clean and refreshed 
    • cell phone charger (nothing worse than being 20 hours in to your shift and realizing your phone is dead) 
    • books / study materials for potential down time 
  • Don't tolerate abuse and mistreatment, but try to have a thick skin. Remember that surgery is stressful, and that the well-being of the patient comes before your feelings. That said, if you feel your are being mistreated, speak to whoever is in charge of your clerkship and report - keeping your mouth shut won't help you or your fellow students. 

Study Resources
  • NMS Surgery Casebook: great for learning how to assess and manage surgical patients 
  • NMS Surgery: fantastic, concise bullet-pointed information about common surgical conditions; helpful for reading up on your patients' diagnoses each night 
  • Pestana Review: case-based review, this is the Surgery equivalent of Goljan Path (very valuable!) 
  • Surgical Recall: nice coverage of basics of surviving a surgical clerkship; best resource for commonly asked pimping questions (and answers!) 
  • Surgery Blueprints: Clinical Cases; a lot like Case Files but more true to the types of questions asked on the Shelf 
  • Access Surgery: great website for reviewing basics of surgical cases and conditions - load on the computers in the OR immediately prior to a case for last-minute review; requires a subscription (many medical schools provide students with access) 
  • As with all clerkships, Pretest, First Aid and Case Files may come in handy depending on student preference 
Cross-posted on November 1, 2012 at metamorphosistomd.blogspot.com

What resources did YOU use to prepare for your surgery clerkship? What other general pointers do you have for students who wish to excel during their third year? 

Share your thoughts in the comments! Let us know what else you would like to see featured on the blog!

~~~

Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She has spent the last year as a Dean’s Research Scholar, dedicating her time to clinical research in the field of Trauma and Critical Care. Having loved surgery from the very beginning, she is excited to embark upon the process of applying to General Surgery residency this fall. She is passionate about issues surrounding surgical education, mentorship and finding a balance between motherhood and medicine. Outside of medicine she enjoys practicing Taekwondo and spending time with her husband and son.



14 comments:

  1. I found it helpful to review the OR board for the next day and use that to guide my studying for the next day, especially Anatomy.

    Learn the small seemingly insignificant things well- all about fluids, electrolytes, nutrition, post-op wound care, etc. These small things show attendings you care and help make a great surgeon!

    And definitely true about the snacks! Keep them stocked!

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    1. That's hard to do for urgent and emergent procedures that aren't on the OR board in advance, but there's definitely no reason not to take every advantage and prepare if you can! Even if something is scheduled last minute, you can grab a few minutes on the computer in the OR (if there is one) and skim relevant information online. It's hard to learn much watching an operation if you don't know what you're looking at!

      Any advice for good resources for students to learn all that crucial information about fluids, electrolytes, etc?

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    2. I like "fluids and electrolytes in the surgical patient" by pestana. And "Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple" by Preston.

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  2. As a clerkship director, I want to reinforce Lauren's comment about letting the person/ people in charge know about mistreatment. Sometimes it is just that you need someone to talk to about abrupt or impatient behavior by faculty or residents, and that's what we're here for. But when it's the real deal, we NEED to know about it. We can't get our colleagues or residents to behave better if we don't know what's happening.

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    Replies
    1. We are fortunate that programs take this very seriously, and that there are people like yourself that are there to protect us. Nonetheless, situations involving mistreatment can be very challenging to be involved in!

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  3. Nms surgery cases, surgical recall, and pestana were KEY! I carried recall in my whitecoat and prepped before a case by reading the equivalent section. I can't agree enough that enthusiasm and being helpful will get you FAR! I carried suture scissors, 4x4s, a selection of tape, etc. I was not necessarily the #1 student (knowledge wise) but I wasn't afraid to ask questions, answer wrong, and express my awe when seeing cool things in the OR. Attendings loved this enthusiasm. I'm not saying you can be an idiot, but if you're excited you'll be fine... if you don't act like a wallflower, you won't be treated like one.

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    1. I agree! Nothing goes as far as enthusiasm in the long run.

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  4. I agree with the recommendations posted. Here are my additions from the resident perspective.

    1. Own your patients.
    As a 3rd yr by the time you are about 2 weeks into your rotation you should be following your patients (1-3). Ideally you have operated on these patients. I would suggest pre-rounding on the patient(s) and presenting them during rounds. This is in addition to your help collecting numbers with the intern on service.

    I realize this may not be a popular idea with work hour restrictions, but it helps the student own a patient's hospital course.

    2. Afternoon rounds.
    After your OR time has concluded help the team by collecting vitals for afternoon rounds. See your patients (those 1-3 that are still in-house), solicit questions from the nurses.

    3. Don't be afraid to go in to the OR to touch base with your resident and attending team if you happened to be scrubbed with another attending. Our OR is open to students. We want your interaction and enjoy teaching and learning from you, especially when you show your interest and care for patients.

    4. Continue to ask, "can I do that". It's easier for the resident to pull the drain, chest tube, open the wound but you will learn a lot by doing this yourself with proper supervision. Even if you are told "no" the first time, keep asking, "can I do that?"

    Have fun!
    liz@berdan.us

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    1. Thanks Liz, that's fantastic advice. I especially like #4 - I've always been pleasantly surprised at how often the answer is "yes". I find that most residents (at least the good ones!) have the insight to realize that someday I, or someone quite like me, could be their junior resident. Any skill or idea learned now is one more you have to bring to the table later!

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  5. Coming off of the previous post, what does everyone think it takes to succeed in fourth year surgical rotations? How can you step up your game so as to be increasingly helpful to the residents on the team and at the same time leave a fantastic impression with the attending staff?

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    Replies
    1. Should we have a separate post on "Success on your sub-internship"? Lots of good information, and it's definitely a different situation than the clerkship.

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    2. That would be fantastic, I hope someone will address this!

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  6. My additional 50 cents:
    1. If you are unsure of surgery  do more surgery rotations. If you are confident with your choice of surgery  do more medicine rotations.

    2. An anesthesiology rotation as a 4th year is great! You get the physiology (dog lab, but on humans!), procedures and you can even scrub in if the surgical team needs an extra set of hands.

    3. SICU rotation as a 4th year is a great way to begin to critically think about patients and get some procedures under your belt (IV, ABG, central lines, chest tubes, etc).

    4. Draw out how you think the operation is going to flow. Review your notes and make adjustments.

    5. Make sure you can do the simple procedures (IV, ABG, foley, NGT, etc)

    6. Own your patients (do you see a theme?).
    If you get a consult on a patient follow up what the other team’s recommendations are (what the data is for their decision, why this treatment vs that, etc). If the patient had pathology  Go to the pathology dept and look at the slides with the pathologist. Go to radiology to see how the imaging is obtained. Scrub out of the case to follow the specimen to the path lab to see how they handle the tissue and review the slides with the pathologist.

    My favorite rotation as a 4th year medical student at MCW was an interdisciplinary rotation for IBD where we spent some time with GI, radiology, pathology and the surgeons. It was an AMAZING experience.

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    1. Thanks Liz, these are really fantastic suggestions!

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