Other Things You Will Want to Know Beforehand

10(+1) Things

The keys to success on the surgery clerkship:
An unofficial guide for P&S students from the surgery residents

During clinical clerkships, medical students often ask, “What is expected of me?” The reply is vague, predictable, uninformative, and often frustrating: “take ownership” and “be a team player.” Students are told these vagaries on every rotation and left to figure out what they actually mean. Here is a list of 10 (plus one) things to do on your surgery clerkship to “take ownership” and “be a team player.”

  1. Be on time. Know when and where morning and evening rounds are and be there on time. Know when cases are scheduled, see patients preoperatively, and get to the operating room on time.
  2. Be accountable. Communicate to your team your schedule for the day. Do this on morning rounds so that the whole team knows and can plan your involvement in patient care. We do miss you when you’re gone, so it helps to know where you are—and remember, if you don’t see us, we don’t see you!  Don’t leave at the end of the day without checking with your team, preferably a senior member, finding out what is on tap for the next day, and signing out any important pending studies or tasks for your patient to whoever is on call. If are off on a given day, be in touch with your team the day before you are scheduled to return to duty. Also, always be accurate and honest in your reporting of information. If you do not know the answer to a question about your patient, say so and offer to find out as opposed to making something up.
  3. Present! Surgery rounds can be quick. Don’t let residents forget which patients you’re following. Step up and present your patients, challenging yourself to present the assessment and plan. It is your time to shine!
  4. Go to the OR. This is why we do what we do…check it out. Read/prepare beforehand and know the patient’s story, the anatomy, the disease, and the surgical management. Intra-op try to anticipate what you might see and watch the dissection. If you’re thinking about these things before the question is asked, you’ll be ready for anything! Follow this patient postoperatively. Keep track of your experience using the patients log record to document your patients, and use this as a reminder to follow up on pathology reports in WebCis, even for discharged patients: who knows, you may be the first to discover that the patient with acute appendicitis hada carcinoid tumor in the specimen—what an opportunity to make sure a patient doesn’t slip through the cracks!
  5. Check on your patients. En route to/from your lunch or lectures, stop in to see the patients you’re following. Do this before checking in with your residents. That way you’ll have up-to-date information that the team may not have.
  6. Be curious!  Since rely pursue a higher level of knowledge—don’t just ask questions for the sake of it. Ask “why” often and seek answers both on your own and from residents. Realize that your questions may say more about you and what you know than your responses. What is the approach to a post-op patient with fever? Why does this particular patient have a fever? Why did we give Tylenol? Etc. Avoid questions whose answers are readily available to you (eg. “Are my patient’s labs back yet today?”“How does Tylenol work?”), and do your best to recognize good moments (e.g., between cases) and bad moments (e.g., elbow deep in blood yelling, “I can’t find the bleeder!”) to ask questions.
  7. Demonstrate “situational awareness.”  Situational awareness is the skill of independently observing, assimilating, and responding to what is going on around you, as opposed to needing to be told directly what needs to be done. For example, during rounds, pay careful attention to the plan for each patient and determine which tasks you can do either on your own or with help. Be proactive and always communicate what you’re doing with the residents. Say, “I will call the ID consult on Mr. Smith. ”Or,“ I heard Mrs. Jones needs her Jackson Pratt drain removed…can you show me how?” Next time you can just get it done!  *This is not a “how to get honors list,” but rather a “how to develop good habits as a doctor list.” The former list does not exist, and it never will.
  8. Avoid “performance preoccupation.”  Remember that your focus should always be on the situation/patient, not on your performance; don’t let fear of making or reporting a mistake get in the way of learning or providing excellent patient care. Don’t take it as a personal reflection of you or your performance if the house staff occasionally seem curt or short-tempered. Also, remember the distinction between Feedback—what you need to improve your skills and get as much out of the clerkship as possible—and Evaluation (your final grade and comments). Proactively request timely, frequent, and specific feedback on your work.
  9. Show solidarity. Do not “one-up” fellow students, interns, or residents. We area team; no one is here to show off, gain praise, or prove anything to anybody. Incorrect information should be clarified, not decapitated, placed on a spike, and paraded around the wards. Similarly, another person’s incorrect answer is not an invitation for you to announce the answer that’s been burning a hole through the tip of your tongue. Swallow it; your time to regurgitate will come. And, while you should by all means advocate for your own needs—take time to eat, tend to academic or personal business as needed—learn to do so efficiently and without abusing the generosity or spirit of others who are working tirelessly along with you to take care of the patients.
  10. Do not confuse scutwork with team work. Removing staples, changing dressings, and pulling drains are helpful, and you do learn by performing hands-on tasks. Writing down the finger-stick results for 15 patients and graphing their trend over 3 days so that your intern can call an endocrine consult is scutwork and a federal offense. 
  11. Have fun. No question about it, a fun person is a team player. Note: you do not have to be funny to have fun, but you do have to be genuine.  Even if surgery is not your future, it is a great opportunity to learn and take part in patient care. Finally, remember to ask for help if you feel unwell in the OR or experience difficulty coping with the stress of the clerkship.