So you think you can surgerize? Well this guide contains the essential tips needed to succeed on any surgical rotation whether it be general surgery, plastic surgery, or ophthalmology. As you already may know, if you want to match into a competitive surgical specialty it is essential to honor your surgical rotations. Suffice to say, it would not be a good look to just pass surgery after you just honored internal medicine (since you read our blog on that (link)). This guide contains the most relevant information needed to succeed in your surgical clerkships.
Let’s first cover the General Surgery Shelf exam. The most useful resources are listed below.
Pestana’s Surgery Notes is a light read. It should be read multiple times over the course of the 6-10 weeks that you will be on your surgery clerkship. Ideally, it is best kept handy in your whitecoat pocket so it can be read in between cases and when you have downtime in the hospital. DeVirgilio’s is precisely the opposite. That book is so thick you’ll herniate a disk if you aren’t careful. However, the layout is simple and it is easy to read. The questions at the end are also great for preparation right before the shelf exam. One pass through the entirety of DeVirgilio’s provides a solid foundation. To round out the reading resources, OnlineMedEd has printable notes. These are quite lacking in terms of detail and background so they are best read as refreshers/for repetition. There are also about 300-400 general surgery questions as part of the UWorld STEP 2 CK subscription. Focus on the answer explanations and management algorithms for abdominal/respiratory trauma. Know how to handle volume resuscitation for trauma and burns as well. Lastly, the previous NBME exams are a great resource to test yourself and see what the real thing will be like. If you want to work up a nice sweat, do these under timed conditions.
Now that we have the studying part out of the way. Let’s get to the fun part.
As always, having the right mindset is key to accomplishing your goals. If you haven’t yet read our Internal Medicine guide go ahead and do so. Proper frame of mind is covered there. Similarly, how to handle interactions with attendings, residents, nurses, PAs, patients, and fellow students is also covered in that guide (Link). These skills are actually even more important on surgical rotations as the stakes can be much higher due to a potentially malignant culture and higher stress situations. There will be times when the attending surgeon will yell at you or strongly criticize you. Resist the reflexive urge to soil your scrubs and start crying. It is during those times that your mindset and willpower will be tested. Think of it in the sense that the residents/surgeons are trying to test whether you have the mental stamina to survive alongside them. Get used to mastering this skill as it will come in handy throughout your residency training as well.
Another important topic to cover is Operating Room etiquette. Many students have changed their minds about pursuing surgery after messing up in the OR. First of all, avoid fainting at all costs. Seems simple enough, but every year there is always one student who falls victim to his/her autonomic nervous system. Don’t let this be you. Take preventative measures- make sure you eat a light snack before going into lengthy cases and stay well hydrated.
Moreover, make sure to make all pre-game adjustments prior to scrubbing in which include adjusting your face mask, making sure the surgical cap isn’t too tight, removing watches/jewelry, and having the proper fitting surgical gown/gloves ready in the room.
The play-by-play breakdown is below. It is best to give yourself at least 30 minutes to an hour prior to surgery start time to follow through all the steps.
The steps listed above are the bare-minimum to making a good impression. In order to make a great impression, suture skills, knot-tying skills, and medical knowledge are requisite.
Suturing is an essential skill to have to be a great medical student on surgery and impress. The best way to get good at suturing is to practice. There are countless YouTube videos on this topic as well. I recommend knowing how to do simple interrupted, simple running, figure-of-8, half-buried, buried, subcuticular, horizontal mattress, and vertical mattress. Get yourself a suturing pad from Amazon which creates less of a mess than suturing a banana or chicken leg. As per obtaining scissors, forceps, and needle-driver it is best to ask your school’s surgery club, a resident, or one of the scrub techs you are close with. Amazon is also always an option. After obtaining supplies, make sure to keep practicing. The times you get to suture at the end of a case is your time to shine.
Knot tying can also be learned using YouTube. Be sure to learn one-handed and two-handed knots and be able to do them in both left and right hands. Dental floss is a great option to improve hand dexterity. For an added level of difficulty, wear gloves.
Lastly, to become an all-rounded surgeon having a wealth of medical knowledge is key. As a medical student, be sure to find out which cases you will be a part of for the next day. To do this, ask your resident or check the OR schedule. Then, the night before, be sure to read up on the cases. Google the case, watch videos showing the surgical procedure, know the relevant anatomy cold, and if implants are being used you may want to look up the surgical technique for that. The shelf preparation outlined earlier should help with building up a knowledge base as well.
Lastly, be sure to have fun. Surgery can often be a brutal clerkship especially if you are trying to match into a surgical specialty. Be sure to enjoy the time and not take yourself too seriously. Know your role, work hard, and have fun. DaVinci will continue to release blogs with advice for students and other inspiring stories. Please message us directly at [email protected] with any topics you would like to see covered.
About the author of this blog: Ronit Shah, M.D. is an Orthopaedic Surgery Resident at Temple University in Philadelphia, PA. Dr. Shah is also a co-author of the Principles of Clinical Biochemistry Textbook from DaVinci Academy.