Clerkship: Surgery

Ok so this is super behind since surgery was my first block but at least it’s getting done, ok? I just wanted to share with you some of my general tips for surviving your surgery clerkship! Because it was my first rotation, surgery really scared me. You always hear about how it’s the toughest, most demanding, non-fuzziest rotation. Well, what you hear is right… for the most part. It was also one of the most eye-opening and rewarding experiences that I have ever had. I even considered going into it for a good portion of this year (peds surgeon, anyone?). My point is: go into your clinical years with an open mind, you don’t know what awesome opportunities you’re going to miss out on if you already have a career in mind.

  1. Arrive early to the pre-op area – I mean, you should arrive early for everything, but arrive at least a half hour before the start of your first case. This gives you time to get situated, find your room, etc.
  2. Introduce yourself to the patient – Always introduce yourself to the patient. Let them know that you’ll be a part of their care, especially if you haven’t met them before/haven’t met them in the outpatient office.
  3. Know your cases for the week – Prepare for cases by going through at least the last H&P note from the surgeon to understand why the procedure is indicated.
  4. Review relevant anatomy and physiology – Calot’s Triangle. The layers of the abdominal wall and the arcuate line. The recurrent laryngeal nerve. These are but a few of the many, many classic structures that you need to know for surgery. Surgical Recall is a great book for pimping questions!
  5. Don’t spend your time on your phone/tablet during the surgery – unless you’re looking up lab values or the note for your attending, this is lazy and unprofessional. Just don’t.
  6. Always find a way to be helpful – Help move the patient to the OR table, pull your gloves and gown if you know your size, do-up the scrubbed in staff, help transport the patient to the bed and to the PACU after surgery. Show that no task is beneath you.
  7. Always be ready to scrub in – I found that asking if the surgeon would like you to scrub is more polite than just going ahead and assuming you’re scrubbing, especially if there are residents/fellows who need the time and practice more than you do.
  8. Keep it clean – Make sure you don’t scrub for a shorter amount of time than the person who ranks above you, no matter how clean you are. And for the love of GOD please don’t touch anything blue/sterile. If you’re unsure, just ask
  9. Watch the surgeon – make note of the settings on suction/coag/bipolar the surgeon likes. Remember the instruments they prefer for certain portions of the surgery, when they want suction, when they want irrigigation, what they choose to close with, etc. Anticipation will make for better workflow and also shows that you’ve been paying attention. At the same time…
  10. NEVER TOUCH THE MAYO TRAY– Unless asked of course (and even if you are, sometimes the scrub tech/scrub nurse didn’t hear the surgeon and may get mad at you anyway).
  11. Be nice to the scrub staff and circulators – They may get mad but a part of the job is to keep each instrument accounted for. Don’t take it personally. Additionally, part of the relationship with the OR staff is built on time and trust. Don’t expect to be trusted not to screw up until having spent a lot of time with the rest of the crew.
  12. Don’t leave unexpectedly – Drink when you can, pee when you can, sit when you can, pee when you can. However, don’t sit unless you’re told to or if you’re going to pass out. Don’t leave the room unexpectedly unless your attending and resident are made aware in advance.
  13. Others
    1. Did you remember to pee again?
    2. Try to watch as many surgeries as your rotation allows – it’s nice to get variation.
    3. Practice tying knots on your scrub pants (ask if you can have an extra set of silk ties at the end of the case).
    4. Practice suturing whenever you can! A pig’s foot is just as good as a sim set.
    5. Just have fun.
    6. When rounding in the morning, keep it succinct and in the S.O.A.P. format. Here’s a quick sample that I just drafted up (almost none of this will make sense if you haven’t had surgery/OBGYN yet LOL – but it’s a nice scavenger hunt if you’re so inclined):
    7. Ms. X is a 35 yo female POD#1 s/p cholecystectomy. No events overnight. S – She has no complaints this morning. She has passed flatus but has not yet had a BM. She is tolerating her diet of clears. She has no complaints of n/v. She is ambulating with help and her pain is controlled on her current regimen. O – Tmax was X with a range of X-X. Vitals were otherwise stable/(mention all of them your first POD and you can state if they were stable or if there is a derangement in subsequent progress notes). Her IVF rate is X. Her urine output is adequate at X (0.5 ml/kg/hr!). Her drains are putting out X ml of (bilious/serous/serosanguinous/sanguinous) fluid. She is in for X, out for X for a total of X (up or down, depending on direction of net fluids). PE – *This section is usually short and consists of only pertinent systems* (for example, is the wound c/d/i or soaked, dehisced, etc?) A/P – POD#1 and doing well. *Consider advancing diet to fulls/as tolerated. Make sure you have DVT PPX – SQH or SCDs for example, GI PPX. Analgesia. Activity – c/s PT? Pertinent labs you want to order?*

I know that was a lot of information but this clerkship requires a lot out of you. Any questions? Feel free to drop me a comment/send me a message via Instagram/send me an email. Best of luck on your rotation!

– TS℞

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