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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