How to Ace Your Surgery Rotation

Karen Horvath, MD, FACSProfessor of Surgery

Residency Program DirectorUniversity of Washington

Objectives

• Goals of rotation• Role as student &

‘performer’• Insights into the other

side• Practical tips from UW

What are your goals?

Goal #1

To learn as much as you can What you learn is

mostly dependent on you

Requires YOUR active pursuit of knowledge

Knowledge

Knowledge in Surgery• Experiential = active

participation – Hands-on, concrete– Changing dressings– Writing notes– Collecting labs– OR & clinic

• Surgical concepts acquisition– Reading for patients– Prep for OR– Studying for test– Pub Med searches ad

infinitum!

Goal #2 for your surgical rotation is to

make a contribution – over and over and over again.

Goal #3

• To obtain an outstanding ‘performance’ evaluation– You are performing

• ‘Deans Letter’ = MSPE comments

• Clerkship grade• Letters of recommendation

– Know your audience!• Attendings, residents, nurses,

patients & families

Who is Your ‘Audience’?• Surgeons are…..

– Detail-oriented– Direct– Concise– Practical– Logical– Linear– Efficient– Organized– Committed– Multi-taskers– Type A (perfectionists)– Strong work ethic – Awesome

Surgeons

• Value patient ownership– Attached to patients in

unique way – Bond of trust from

surgical event

• Value ‘appropriate’ initiative

Surgery is a team sport!

The interns / residents as your ‘audience’.

A primary goal of internship is

learning to avoid sabotage.

What are Saboteurs?

• Intern’s mission:– Take good care of patients – Prevent problems &

complications– Facilitate care (get pt home

ASAP)– Get the work done efficiently – Look out for team members

(pain prevention tactics)– Look good in the process

• Saboteurs are people who unwittingly try to kill your patient, your mission – or you!

No Suprises Please!

• Potential saboteurs– Medical students– Other residents– Nurses– Faculty!

• Methods of operation (med studs)– Not being 100 % reliable – Say you’ll do something & not

come through– See a problem & not tell resident– Cause a delay in care

SURPRISE!

Practical Tips

SIESyndrome of Inappropriate Enthusiasm

• Displays of useless energy akin to entropy

• Aka ‘Smoke blowing’ • Includes brown nosing

Substitutes for hard work

SIESyndrome of Inappropriate Enthusiasm

• Includes back-stabbing• “Some kings stand taller by

making their subjects kneel” (an illusion) – Don’t promote yourself by

stabbing others– Obvious even when ‘subtle’– Support your colleagues – Be seen as a team player

You don’t want to go here.

Rotation Expectations: General We expect your best   Push yourself   Surgical care = balance & efficiency  

“Asked to do more than you think you can do in as little time as possible.  

Try. You may fail. You’ll get better.” Jump in

Good attitude Menial tasks count for the team as much or more than

‘important ones’. No task too menial

“Cleaning latrines: it's one way to learn that each man's labor is as important as another's.” – M. Gandhi

Rotation Expectations

• Have a card system for your pts• Know EVERYTHING

• Pretend you are patient's only doctor• Make patients rely on & trust you• Write notes • Rounds = Anticipate, Anticipate!!

• Prepare• Dressing supplies ready • Help takedown dressings • Write orders & get co-signed

Rotation Expectations: Presentations

• Present with purpose & quality, NOT Quantity

• Plans• Always make one• Make your own • Concise • SO…….AP

• Read every day

Rotation Expectations

• Track patients throughout day • If patient having test... Help make it happen • ‘Bird dog’ labs, tests & consult notes• Events = notify residents

• If you have left over time – help others

Rotation Expectations

• Go to OR whenever possible  • Tie knots & ask for help • On-call

– Help with notes, consults, post-op checks & evaluating patients 

– Stick to intern ‘like glue’ • Don’t disappear – people notice

• Notify someone• Mid-rotation, ask for feedback

Summary

• To get the most……give the most

• People notice & the rest falls into place

• Don’t worry about competing

• Actively participate in all functions of the team

• Most of all….Be kind

Patient

“If I’d known what it was like to be a patient, I’d have been a much kinder doctor.”

Bruce Gilliand, MD

Bruce C. Gilliland, M.D.Professor of Medicine

Division of RheumatologyProfessor of Laboratory MedicineAdjunct Professor of Microbiology

American College of Rheumatology Master1931 - 2007