Clerkship Advice | Third Year Surgery

Posted on July 12, 2011

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(Non-medical friends: this is an analogy for how much we carry in our pockets).

The third year of medical school can be just as scary as it is exciting.  It’s great when you have someone who can tell you what to expect on your rotations, but that’s not always the case.  Because of that, I’m planning on summarizing most of my clerkships so other medical students may benefit.

I was worried about surgery being my first clerkship, because it’s generally held to be one of the tougher rotations.  I made some observations in a previous post about difficulties encountered by medical students & interns, which I think was misinterpreted by more than a few readers.  Make no mistake, I thoroughly enjoyed my surgery rotation – it afforded me the opportunity to work with some of the most brilliant and inspiring physicians I’ve met to date, and instilled in me some interest in a field I honestly wasn’t considering (and that’s the point).

Even if you know you don’t want to be a surgeon, this may be your only opportunity to see some of the amazing things that happen in the OR, so give it a chance and keep an open mind.  Here is my core advice for this rotation, with resources to follow:

Be ready to let things roll off your shoulders:  This is probably the most important thing you need to learn to survive this clerkship.  Surgery is fast-paced and residents/attendings will want you to fire off stats about your patients in the proper order.  Don’t be upset if they snap at you, because they probably won’t remember it 5 minutes later.  It’s highly dependent on the personalities of the doctors you work with.

Life goes on:  Surgery will have you dealing with the most acute and emergent issues in the hospital, especially if you work with the trauma team.  It may be difficult for some people to transition from an environment where students are encouraged to be ultra-sensitive and compassionate with standardized patients to one where the daily grind is such that suffering is routine.  I remember bringing a patient for a CT scan – he was scared and in such great pain that all he could do was moan & grimace.  When I entered the shielded control room to rejoin the team, I was asked by one of the residents what I wanted for dinner – they were ordering Chinese.  Now, you can’t break down in tears over every bit of misfortune you witness, but my advice is to find somewhere between compassion and callousness that allows you to get the job done.

Be assertive:  As someone who is typically reserved & cautious, I struggled with this the most.  Sometimes, you just have to jump in there – volunteer to observe or assist with procedures or you’ll never learn anything.  Not all doctors will offer, but most will be happy to let you try.   One caveat:  there’s a fine line between enthusiasm and gunning (but you’ll never be able to please everyone – chances are, if you ruffle just a few feathers, you’re doing it right).

Know your limits:  If you don’t know something, admit it (especially if it’s something regarding patient care).  If you don’t know how to do something, ask for help.  If you don’t feel comfortable doing a procedure, speak up.  And most importantly, if your vision narrows and voices begin to sound more distant, back the hell out of the sterile field – you’re gonna faint.  No one will yell at you for removing yourself appropriately, but you sure would catch hell for trying to be a tough guy and falling head-first into a bowel resection.

Eat when you can:  You never know when you’re going to be called into a really interesting case (for me, it was a kidney transplant), or when you’re going to encounter unanticipated complications (like the laparoscopic appendectomy where I wound up working the camera at an awkward angle for 3.5 hours).  Stuff your pockets with nutrient-dense snacks – candy bars are not really a good idea.

Carry basic supplies:  Part of being a surgical clerk is serving as a pack mule for your team.  You should always carry with you:  a suture removal kit, sterile gauze, abdominal pads, several types of tape, sterile gloves, trauma shears when appropriate, and a handful of alcohol prep pads.  Always know where the nearest supply room is, and make sure you have the code.

And finally, perhaps the best practical advice I can leave you with was passed down by an upperclassman to my friend:  “The shit gets real fast and you probably won’t be ready for it.”  Seriously, though, take it one day at a time.

Practice in your down time:  Go through procedures in your head, bring a shoelace or some silk ties to practice your knots, and if you like, buy some pig’s feet to practice suturing.  Most schools/hospitals have laparoscopic training equipment for their residents – try to get your hands on this stuff if you didn’t grow up playing video games.

In addition to practicing their ties, students practice their surgeon's temper by ripping the call room phone out of the wall.

Resources:

Sample Pre-Op Note (PDF – right click & choose “save link as” to save a copy) – Look like a superstar when you sneak this into someone’s chart for the first time.

Breast Surgery notes (PDF – right click & choose “save link as” to save a copy) – Some sloppy but potentially helpful notes I compiled before a mastectomy.

Surgical Recall – This is a good book to read in your downtime or before an operation, and it should fit in your coat pocket.  It’s not nearly detailed enough to get you through the rotation alone, however.  Also, I found there were a few copies in the various areas surgical clerks hang out (e.g. the PACU), so you may want to hold off on buying your own copy.

Schwartz’s Principles of Surgery – I used this to read about the “meat & potatoes” topics for general surgery:  appendicitis, bowel obstruction, cholecystitis, etc.  Chances are, this is available through your school via AccessSurgery/AccessMedicine or is on reserve in your library.  I am not recommending you purchase this.

Cope’s Early Diagnosis of the Acute Abdomen – A good read for the aspiring surgeon; check to see if this is on reserve or if someone on your team will loan it to you.  Definitely a good read if you’ll be taking a lot of call alone – you will see, diagnose & treat acute abdomen.

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