Welcome to the New AWS Blog & Tips for 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?

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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.