By Anna Sabu Kurian
Third year of medical school is one of the most important and interesting times because it helps you find your specialty of choice in medicine. The world of surgery might seem intimidating as a medical student, but there is enough room for everyone to learn and make the most out of the clinical rotation. The clerkship duties include daily rounds, operating room experience and clinics.
Here are a few suggestions for the optimal third year experience in the operating room
- Read about the specific surgical procedures the night before they are scheduled. Make sure to review the anatomy; and vasculature of different structures involved. The surgery textbook by Dr. Virgilio is a good resource.
- Practice suturing, one hand ties (make sure that you know how to do them with either of your hands), two hand ties and instrument ties. Reference below for a video tutorial
- Once you get to the hospital, introduce yourself to the patient in the pre operative area.
- Introduce yourself to the nurse, scrub techs and anesthesia team in the operating room.
- Grab your gloves and gowns and hand them to the team in the OR.
- Help the OR team to transport and prep the patient for the case (Always abide by the instructions of the residents and attendings). It is important as a future surgeon to know how to prep and correctly positioning the patient for a variety of procedures.
- Text/ communicate with the resident/attending once the patient is in the OR and is getting prepped and inducted.
- Be a team player and see where your help is needed before, during, and after the case and communicate clearly with your seniors and residents.
- Once the case is done in the OR, help get the patient to the PACU and stay with the patients until you get the first set of vitals. It’s always good to inform the resident on the case when the patient is in PACU, if they have been extubated and if their vitals are stable post-op.
A few tips to keep in mind when rounding on surgical patients.
- Round on your patients before you round with the residents and attending as a team (Pre-round).
- Always make it a point to talk to the nurse for your patient as they might have valuable information that you might miss out on.
- Have appropriate supplies (wound dressings, suture removal kit etc) ready in the room before you round with the attending and residents (Saves a ton of time during official rounding, especially when you have a busy service).
- If there are tasks to follow up on after rounds, make sure they get done. For instance, if a CT is ordered for increasing abdominal pain make sure to keep an eye on it and update the team in case they are busy with other patients.
- Please see the link below for a concise guide for your daily round presentation on surgical patients.
Keep these in mind for surgery clinic days
- If time allows, chart review a few patients the night before the clinic and have an assessment and plan in mind if possible. When you are in the clinic, you can learn as to how your initial plan aligns with the final plan for the patient.
- When in the clinic get a complete H&P, do an appropriate focused physical exam and report back to the supervising physician. Always attempt to present your assessment and plan as well. It may not be completely correct, but we all need to practice critical thinking to improve on our skills
- Be ready in the patient room with supplies you would think might be necessary for the specific clinic visit (Ex: Staple remover, Dressing changes, Iodoform packings)
One last thing to keep in mind is that, you learn from everyone on the team, which includes the nurses, scrub techs and the anesthesia team. Be humble and be ready to learn a lot of material in a short amount of time. Keeping an open mind, helping your team within your capabilities and being respectful of everyone on the team will get you to success!