How to impress on your surgical rotation - medical student edition

I get questions all the time from medical students on tips for success on their surgical rotation, so I thought I would write a blog about it. I was a medical student only 6 years ago and I remember all the nervous feelings there was before starting new rotations, especially a rotation that you were actually interested in for your future career.

Growing up, everyone always tells you that getting into medical school is the hardest part and unfortunately that just isn't true. The hardest part is matching to the specialty of your choice. Imagine going through 8 years of schooling to realize that you don't actually get to be the kind of Doctor you want. What I will say is if that does happen to you, keep your chin held high. From what I have seen with friends and colleagues who have gone through that, is that it was probably best and they always seem to end up happy. On the flip side, I will say is if that does happen to you but your calling really is to be x,y or z then don't give up, there is always a way to get back to your dreams even in residency, you just have to fight for it.

Anyways enough about that and let's get to the tips. I am going to divide the blog into two categories; advice for your first surgical rotation - applicable to all clerks and then some extra tips for the 4th year gunners who are trying to match to a surgical specialty.

Be humble. This is a general announcement for the current generation of medical students. There is an air of entitlement that needs to go. For example, cardiac surgery is a subspecialty, which means at the University I am training at, medical students are no longer obligated to round in the morning because there were complaints that there is "no learning", and then they would complain that their operative experience is minimal. Let's remember, it is a real patient on the operative table and if you haven't put in any effort into their patient care preoperatively, why do you think you deserve to scrub?

Le's start with the first surgical rotation.

1. Be on time: That generally means earlier than the resident, I am not saying you have to pre-round, but just a few minutes before shows you are ready for the day. We might not have time to whip out a powerpoint and teach you on rounds, but if you are open to learning you will learn from experience, for example - what does a surgical wound look like fresh from surgery, what are we looking for to progress a patient, when is a patient ready for discharge and safe to go home. You of course will learn other life skills that are essential to being a doctor someday such as - how to be extremely efficient, how to recognize a sick vs. nonsick patient, what it is like waking up extremely early to get your day started, etc. There can always be learning in medicine, you just have to look for it.

2. Be helpful: This may seem obvious but it is amazing how little medical students know how to do this. If you really don't know how you can be helpful in any given situation, just ask someone. The resident, the nurse, the staff, just ask- "How can I help". When you're in the operating room (or anywhere for that matter) and we see you on your phone it is an immediate red flag. I know that these days, there are so many helpful apps and books on your phone BUT when you're in the middle of patient care, being on your phone is not helping anyone. If you're in the OR, put some gloves on and help transfer the patient or help the nurses with whatever they need to get the case started or finished. SO easy.

3. Be prepared: Again this will vary depending on your interest but there are a few minimum things you should do. The OR slate is posted the day before. Sometimes in fast paced operating rooms, the OR slate can change at a moments notice, but that shouldn't deter you from looking up the next day, the day before. At minimum you should know what surgery we are doing on the patient and the basics of what that means.

4. Learn how to read the room: There is definitely a fear amongst medical students that there is a "game" being played. Trust me, there is such thing as being too keen. At the end of the day or the end of a clinic or whatever it may be, you should always ask the person you are with, "is there anything else I can help you with?" If they say no, then you can ask one more time and if they say no again, then you LEAVE. This isn't a game, it isn't a trick, I promise.

Again, these are the bare minimum expectations we have of a medical student. If you can follow these simple tips then it is way more likely that you will get to scrub in the operating room and even get to be apart of the case, like close a wound or tie in a tube. If you actually have zero interest the specialty and do none of the above, that is fine too, just don't complain to your program that you didn't get a good operative experience, because let's be honest, did you deserve it?

Now here are a few more additional tips for those 4th year gunners. All the above applies to you as well but our expectations are going to be a bit higher.

1. Be on time, meaning pre-round: the expectation for you would be to pre-round on your patients that you've operated on. I don't mean round on the whole ward, just the patients you were personally involved in. If of course your resident has indicated that they don't want you to do so, then don't, again this is not a trick. I think seeing the patients before your resident is a good idea. It shows that you care and it can also show that you have some basic understanding of postoperative patient management. Be bold and suggest a plan.

2. Be prepared, basic anatomy, basic indications, basic pitfalls/complications: again this goes above what I would expect from a medical student not interested in the specialty. Ideally, you know the cases you are going to be involved in the next day, the night before. You can then read up on the cases and ask insightful questions and when asked a question show that you've read around the case.

**I think it is really important to emphasize that we DO NOT expect you to know everything. If you get a question wrong, it is not a big deal, we all get questions wrong. Just shake it off. The appropriate answer is to simple say "I don't know, but when I go home I am going to read more about it."

3. Surgical skills: similar to the knowledge, we don't expect you to be experts or even proficient for that matter. There are however some basic skills you should have. Simple interrupted suturing, horizontal mattress, vertical mattress, running subcuticular, single hand tie and being able to secure a drain. You never know when in the operating room you are going to be given the opportunity to showcase your skills, so when you do, you want to be ready. Practice, practice, practice. My friends and I used to have Friday wine nights with a couple of pigs feet to practice. Another way to get practice in is when you're relaxing watching a movie or a TV show for example, have a package of silk ties, yarn, shoe lace, and just hand tie over and over agin.

That really is all there is to it. I've always believed that surgeons are relatively simple people. Generally speaking we love what we do and all we want is to be around individuals who also love what they do. We like to see medical students who are teachable, affable, and reliable.

I hope you've found these pieces of advice to be useful and good luck with your upcoming surgical rotations!