Surgery Clerkship Tips: Making the Cut

Torey here! Overall, my experience in surgery was a very positive one. Our school breaks up our two months on surgery into one month of general surgery, two weeks of a specialty (mine was pediatric surgery), one week of night float, and one week of SICU. During all of these rotations I felt that I was surrounded by residents and attendings who generally enjoy teaching, which really fostered an interest in surgery that I never would have expected.

Approaching the start to surgery, there was a lot of buzz surrounding the clerkship, especially since it was the first one I rotated through.  Regardless of what you hear, make sure to take it with a grain of salt. So much of your experience is dependent on your residents and attendings that what one person’s experiences may be completely different from another’s.

What I heard. Early mornings… long hours… you’ll either love it or hate it… scary pimp sessions with attendings…

My take. Surgery is what you make of it. If you go in with expectations that you’re going to hate it, then every bad thing that happens will only reinforce that expectation. If you adopt the right attitude, you can shift almost anything into a positive light which can drastically impact your experience (and performance). You guys already know my take on early mornings (see our previous post Early Bird gets the Best Parking Spot: The Benefits of Being an Early Riser). The long hours means more face time with residents and attendings which means more opportunities to learn and show them what you know. The “pimping” done by attendings became a lot less scary when I started thinking of them as learning opportunities. Often, that is exactly what they are and is a method that the attendings use to teach and evaluate.

These are just a few things to think about when approaching the start your surgery clerkship. Below is a list (non-comprehensive by any means) of other tips and resources used. Hope this helps!

General tips:

  • Don’t just be on time, be early. Preparation is essential. The more time you have to prepare the better you know your patient. This also gives you more time to practice your presentation skills. PRACTICE PRESENTING IN THE MORNINGS. Whether it be to a wall or a fellow med student you are rotating with, solid presentations will make you look much better in the eyes of senior residents and attendings.

  • Read up on every patient you are in the OR with. Know WHO the patient is, WHAT procedure they are having, and WHY they are having it. Many times the first question I was asked in the OR was “why are we doing this procedure.” Preferably, you would know what planned procedures are going on the night before so you can also read up on the relevant anatomy, but that isn’t always the case.

  • BE NICE TO EVERYONE. This should go without saying, but you’d be surprised. We’ve heard horror stories from the residents about previous medical students and there are usually a couple choice adjectives used to describe those students.  Introduce yourself to the scrub techs and nurses in the OR, offer to help whenever possible, ask them questions about what they are doing or how to do certain things. If you prove to be a decent human many times the scrub tech will hand you instruments that the attending will need and it’ll make you look good!

  • Know your attending’s/resident’s glove size. Grab a pair of gloves for your attending or lead resident when you walk into a patient’s room while rounding. Then, when they are about to perform a physical exam, they do not have to walk around the room to grab a pair or take time asking for some. This saves time and makes rounding more efficient, which most attendings/residents appreciate.

  • Be a walking supply closet. This may only pay off once or twice during your rotation while rounding, but when it does you look like a star. Ask your resident what they use often when rounding and fill your pockets with them. I carried gauze, tape, a suture removal kit, a saline flush, and most importantly, packets of lube (seriously, this is the most common thing I was asked to grab).

  • Know about incentive spirometry. Impress your attendings and residents by helping ensure post-op patients have an incentive spirometer, know how to use it, and are ACTUALLY USING IT. Obviously, know how to use one before teaching others. Ask your resident where you can get them on the floors and have them give you the quick run-through of teaching a patient how to use one.

  • Print out copies of your topic presentations for your residents/fellow medical students. You will be asked to present certain topics throughout your rotation. I tended to draw pictures of anatomy accompanied with relevant notes or printout a decision tree from UpToDate on the topic.

Things to consider purchasing before you start:

  • WhiteCoat MedInfo clipboard. I love this because it keeps all my notes organized and in one place. It conveniently fits in my white coat pocket and allows me to keep my notes neat while rounding. A little spendy (about $30) but totally worth it.

  • Maxwell Quick Medical Reference. This pocket-sized book is a great overview of many of the basics you need to know for the hospital, regardless of the clerkship you are. It contains lab values, note templates, physical exam review and other miscellaneous scales/algorithms that might come in handy.

  • iPad. Helpful, but not necessary. Be careful to not be that medical student always looking down at a screen. This is more so a way to be able to look things up about your patient (or about topics you’re unfamiliar with) when the time is appropriate.

Topics to research before you start: (comment below with any other suggestions based on your experiences!)

  • Systemic Inflammatory Response to Sepsis (SIRS) criteria

  • Glascow Coma Scale (GCS)

  • Primary trauma assessment (ABCs)

  • Secondary trauma assessment (head to toe exam)

  • Vital sign ranges (ask your residents on day one)

Study Resources:

  • Dr. Pestana’s Surgery Notes. This book condenses the essentials of surgery into a little over 130 pages which can be brushed over in one day easily after the first run through. It also consists of 180 questions that, while on the simple side, are high yield. This was consistently recommended by the fourth year students before me, and I highly recommend it for those that follow.

  • OnlineMedEd. Narrated videos about specific topics within surgery. They include high yield information and decision trees that I found very helpful for building a framework to work off off!

  • De Virgilio’s Surgery: A Case Based Clinical Review. A much more thorough surgical review than Pestana’s. Many of my classmates read this straight through once or twice and used it as a primary source. I used it as a reference and may have utilized it as a primary source if I had started earlier. This book includes questions for each chapter that I found helpful.

  • Emma Holliday Ramahi’s surgical review video & PowerPoint. This is a 2-hour video that glosses over the basics. Great for reviewing and the question/answer format helps you quiz yourself and see what you need work on. She does these videos for other clerkships as well!

  • Surgical Recall. Think of this book as “survive attending pimping 101.” I used this book to read up on the anatomy and relevant information (both high and low yield) of the next surgery I’ll be sitting in on. Way too much information to read straight through but great for referencing for relevant cases.

  • U-World questions. Great questions, great explanations. Used by everyone I know.

  • NBME practice exams (x4 available). Personally, I find that the more practice questions you do the better. While these do cost about $20 each, to me,  replicating exam conditions once or twice is worth it.

  • Other resources I’ve heard others use include NMS Case Files: Surgery, First Aid for the Surgery Clerkship, and Firecracker. Although I’ve used Firecracker in the past, I didn’t use any of these resources for the Surgery shelf.

If you have any questions, don’t hesitate to shoot us a message on our Instagram page. Feel free to comment on any of your tips you learned on your surgery rotation in the comments below!

Be aware that differences between hospitals and hospital systems make these tips applicable to some more than others. Using common sense and evaluate appropriate times to utilize these tips. These experiences and opinions are our own and do not represent the views of the hospital where we rotate.

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