10 Tips to Survive a Surgical Clerkship

I am now on my 2nd of 8 weeks of my general surgery rotation. I thought I would share some of the tips that are helping me get through this rotation so far 🙂 

  1. Invest in a good alarm clock: I have been spoiled in my past 10 months of rotations, with most of my days starting anywhere between 7-10 AM. On surgery, most of our first cases begin at 7:30. This means I have been getting up at 5:45 to give myself enough time to make breakfast, get to the hospital, round on my patients, and scrub prior to the case beginning. (I know for many of my friends at other hospitals, 5:45 AM would be considered “sleeping in” on a surgical rotation, so no complaints here!)  Although I call myself a “morning person” I have a terrible habit of not going to bed as early as I should be which has turned me into a chronic snoozer. I realized very quickly I needed to figure out a way I could wake up and avoid the temptation to hit snooze, and that is when I found the world’s most effective (and most annoying) alarm clock: ALARMYALARMY is a free app that is available for both Apple and Android devices. The alarm requires that you either take a picture of a location of your choice in your home, shake your phone a preset number of times, or do a handful of math problems (my fav).
  2. Eat! Although I work in a fairly small hospital, I have yet to be done with any of my cases, before 2pm at the earliest. If you know me, you know two things about me: I love to eat and I get real hangry. To avoid exposing the OR to my unreasonable nature when I’m hungry, I make sure to have a big breakfast before leaving for the hospital and I pack my pockets with snacks and try to eat something between every case. Low blood sugar and blood and gore don’t make for a good combination.
  3. Suture, Suture, Suture. I spent the weekend before my surgical clerkship began practicing how to suture on a pig’s foot. I walked into my first surgery fairly confident in my suture technique, but when my attending allowed me to close it took me well over 10 minutes to put in 5 stitches. I continued to practice every night, and by my second week, I could keep pace with my attending as we sutured. I used Duke’s Suture Skills Course and Dr. Omedary’s Surgical Knot Tying video to teach me the basics. I think it’s important to practice knot tying both left and right handed. Often times as a medical student you’re off in the periphery and you might not be in the ideal spot in the OR when the attending allows you to suture. Also practicing knot tying with both hands will improve your dexterity, which will help in the long run.
  4. Study the Surgery Schedule. Before leaving the hospital for the day, check the OR board to see what surgeries you’ll be doing the next day and then go home and study! There are some awesome videos on YouTube that feature real footage of the surgery, and many of them include pertinent anatomy. I recommend School of Surgery’s  videos.
  5. Learn about your patients. This should be universal for all rotations, but I found that unlike on my IM rotations, I had to be able to recall my surgical patient’s much quicker due to how fast paced our rounding schedule is.  In general, keep your presentations brief. Know what postoperative day it is for your patient, and always take note of vitals, I&O’s, diet, incision site, bowel sounds, flatulence, and bowel movements.
  6. Stock those pockets! I make sure I carry around a  spare pair of sterile gloves in my size, 4x4s, tape, and alcohol swabs in my pockets in addition to my standard gear (pen light, stethoscope, reflex hammer, pens, and a notebook). When rounding on a patient in the ICU, my attending decided to put in a femoral line emergently. Having all the gear ready allowed me to assist in a procedure I might have missed if I was unprepared.
  7. Make friends with the OR staff. Before I started my surgery rotation, I stopped by the surgery department to introduce myself. One of the scrub techs I met, allowed me to take home a needle driver and expired sutures to practice with prior to starting my clerkship. The OR staff will have to assist you in getting into your sterile gear, and will hand you tools and equipment. If you develop a good rapport with the surgical support staff, it’ll make your time on your surgery clerkship go much more smoothly.
  8. Don’t take criticism personally. Working in the OR is intense. Surgeon’s often have high expectations of how they want their operating room run and tensions run high during surgeries. Just remember, that they are not personal attacks. Take note of what is being said to you, and don’t make the same mistake again. Learn your surgeon’s mannerisms and how he likes his or her OR to run, and try to anticipate what he or she may possibly need.
  9. Learn the ins and outs of the OR. A lot of time on your surgery rotation will be spent just getting used to working in that environment. The OR is it’s own microcosm. Find a resident or scrub tech and ask them to teach you proper scrub technique prior to your first surgery.  Learn where the lead vests are stored. Be cognizant of your sterile field (keep your hands up, and don’t touch anything that isn’t touching where you’re operating). Begin learning the name of basic tools used in the OR so you can know the difference between Beckmann-Weitlaner Retractor and  Volkman Finger Retractors.
  10. Enjoy the experience. Surgery isn’t for everyone, and that’s okay. Even if you are 100% sure that surgery is not for you, how many times in your life will you be able to say you had your hands inside a man’s belly? Or that you got to help remove a tumor? Or that you held a gallbladder in your hands. Regardless of your feelings towards surgery as a career, a surgical clerkship provides many unique opportunities the average person does not get to experience! Jump at every opportunity you can.

 

 


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