Hey guys! Since people are about to begin to third year, I thought I would recap some tips and tricks that helped me out on each rotation. A few people have asked about surgery so here goes! Don’t forget to check out the ones I already have for obgyn and family medicine.
I had surgery from January to March of this past year at a small community hospital. I was lucky in that it was just me and one other student so I got to scrub in and see a ton of cases! In case you missed it, I’ve also got a post about a 24-hour call day for surgery.
- Carry medipore tape, 4×4 gauze, scissors, and suture removal tape on you so you can hand them to the resident when they’re changing or re-dressing a wound.
- Always have granola bars or some form of sustenance, and refuel when you can between cases. I really liked the Special K Protein bars and having a small ziplock of nuts+granola in my pockets. The hours are long so you have to keep up your energy!
- Never ask to go to lunch and never ask to leave early. My hours ranged from 5AM-6PM on General Surgery and then varied depending on the subspecialty. Some days I would stay until 11pm because the case was complicated. It’s all part of surgery and to be expected. Don’t have hopes for getting out early and you’ll never be disappointed 😉
- I was always freezing in the OR and I bought these velvet lined leggings which saved my life! Our hospital didn’t let us wear anything with sleeves longer than the scrubs, so I usually layered a tank top under a t-shirt.
- Develop a thicker skin. Surgery is a demanding field with long hours and a sick patient population and there’s a lot of stress. Few people, if any, mean badly so try not to take anything personally.
Tips for the OR:
- Always introduce yourself to each person in the OR and offer to get your own stuff. I’m normally pretty shy so I had a hard time doing this. Just say something along the lines of “Hi, I’m _____ and I’ll be the medical student in this case. Would you like me to grab my gloves and gown?” Trust me, it makes a huge difference because the scrub nurses can make or break your experience in the OR.
- Offer to grab your resident his/her gloves. Not necessary but it doesn’t hurt when you’re also grabbing your own.
- Before stepping into an OR, double check 3 things. 1) Bouffant, 2) mask with eye protection, and 3) booties over your shoes.
- There’s always something you can help with in the OR. Bringing the patient in, transferring them to the bed, removing arm boards, etc. Don’t stand there and wait to be told what to do – always offer to help.
- If you’re not sure if something is sterile, always ask. Better to ask than to assume and contaminate something! The sterile parts are from the shoulders to the belly button, so I usually stood with my hands clasped at my stomach.
- In the beginning of my rotation I was only retracting and suctioning. It was cool for the first few days and then I got bored. As you get more comfortable and get to know the residents/scrub staff better, volunteer or ask to do more things. I was really nervous when I started but as a resident was closing I asked if she would review knot tying with me and to my surprise, she said yes. Instead of fumbling around in the skills lab like I had been, I got a chance to really learn how to do a two-handed tie. Of course, always try to gauge the situation and never ask if the cases are behind or if the resident has a lot going on.
- If you know the cases you’re going to be scrubbing into for the next day, read up on it the night before to prepare for any questions. I recommend reviewing some anatomy, indications for the procedure, and pathophysiology of the disease process. Surgical Recall is a great source for this! More on books below.
If you have the chance to choose, I recommend doing Medicine first. I thought this shelf exam was one of the harder ones of the year and I didn’t have Medicine before Surgery so I knew I had a lot to study. The shelf does not ask you about anatomy or procedures; it asks you about medical management of surgical patients. I wanted to do well for the shelf so I used a ton of resources.
The ones I recommend are bolded below.
- Online MedEd – a series of free lectures online aimed at review for medical students in their third year. I find most of their stuff to be too surface level for shelf but, as always, it’s best for the first 2 weeks of any rotation. It actually follows Pestana really well for the Surgery lectures so I recommend getting those two done first! I also did the GI and Renal lectures from OME.
- Pestana (Amazon) – the thin purple book that I always carried around in my pocket. Again, not enough for the shelf exam but definitely a good overview of things to expect. I read this in the first two weekends and then again the day before the shelf exam. Easy to get through and it hits a lot of big topics.
- Case Files (Amazon)- I started out with this book before NMS casebook, and wish I went straight to NMS. This book didn’t feel like it was enough for the shelf exam and a lot of the material was repetitive after OME and Pestana. However, I do recommend it as a good guideline for oral exams because they walk you through a case with the initial workup, diagnosis, and treatment. Another recommendation for oral exams would be the ABSITE Review Book by Pfizer (Amazon). It’s a lot of information and beyond the level of a MS3, but I borrowed a copy from my resident and found it helpful for the oral exams.
- NMS Casebook – I believe there’s a new edition out now (Amazon) but I used the older one and it worked fine (Amazon). I thought this was a great resource for the shelf exam, especially since I hadn’t had Medicine yet. I skipped over the procedural steps but read everything else. This book was longer but much more in depth. I read it twice for the shelf exam and thought it was one of the best for the shelf.
- Surgical Recall (Amazon) – this book has a Q&A outline which made it difficult for me to read. I highly recommend it for questions in the OR, especially for anatomy. It wasn’t helpful for shelf since the exam is more medicine-oriented, but it’s an absolutely necessity for pimp questions.
- UW Qbank – I thought the Surgery questions were slightly easier than the shelf exam. A lot of them asked information covered in Pestana, which is great for solidifying that knowledge but not enough for the shelf exam. There was no way I had enough time to do all of the medicine questions so I decided to focus on GI, pulmonary, and renal. I’m glad I did because on the exam there were a decent amount of questions that were related to those topics.
- Emma Holliday from UTHSC (link here) did a series of lectures for shelf exams, and she covers all of them but Family Medicine and Ob/gyn. The lectures range from 1-2hours and are great for the few days before shelf exams. The Surgery one was awesome and touched on some material that I realized I needed to go back and review.
Surgery was one of my favorite rotations despite the difficulty and the long hours. I hope this was helpful, and good luck to all of the third years who are starting!