I wrote kind of a depressing post, about being tired, and not having any days off for several weeks, and worrying about next year. No fun. Just as well, the computer ate it. I guess the computer knows best. In response to requests (and because I actually know more about this subject than about advice for interns), here we go. . .

Bear in mind that this advice is specifically directed to students on surgery clerkships. Some things would get you high praise from medicine doctors, but will only get you laughed at by the surgeons (writing three page history and physicals, taking care to include a detailed social history; mentioning the eye exam or neuro exam in your report, if it’s not specifically relevant). Conversely, some things will fly very well with surgeons, but will not get you high marks on the medical service (carrying lubricant, gauze, and scissors in your pocket; being prepared to give details of all the patient’s previous surgeries if asked for).

Let’s hit three highlights:

1. Good books: the books I liked best as a student were Pre-Test: Surgery (also excellent for all the core SHELF exams) and Surgical Recall. Those two alone are nearly all you need. You can read Schwartz or Sabiston in the library, but those two you should buy, and carry one in your pocket. Pre-Test is a little harder than the SHELF, and covers all areas. The SHELF does include a lot of medicine-type knowledge, so surgery alone won’t get you through. If it’s your first rotation, you’ll just have to pay extra attention to the medical side of the surgical patients. Recall is nearly miraculous in its ability to predict what questions you’re going to get pimped on. If you know the facts from Recall, you are guaranteed to come across as intelligent and studious in any area. If it’s not in Recall, your questioner probably won’t be too unhappy if you don’t know it.

2. Attitude: People who walk into a surgery clerkship telling themselves, “I know surgery is not for me. This is going to be a horrible three months of waking up early, standing for long hours in the OR, and listening to conversations about blood and guts, which are completely boring to me,” are obviously going to have a bad experience, and give their residents and attendings a bad taste, too. Surgery, for students, is about observing the cases, and following your own patients. Even if you know for sure that you’re not going to be a surgeon, you will see patients who have had surgery, or who need surgery. You need to have a basic understanding of when a patient is sick enough to benefit from surgery (but not so sick that they’ll only die of it), and some idea of the pre-op workup the surgeon will want in order to be interested in the patient. You also need to have some understanding of the effects of various surgeries on the rest of a patient’s life (cholecystectomy is liable to give you diarrhea and discolored stools; that’s not unusual, and shouldn’t be concerning), and some idea of what the postop complications may be.

If you just want to survive surgery, you need to know that you will learn some beneficial things. If you’re aiming higher than mere survival, you need some enthusiasm. If you’re offered the chance to scrub in, take it. Don’t make us ask you twice (because we won’t), and don’t give excuses like “I’m tired,” “I want to eat lunch/dinner,” “I have a test to study for.” Everyone’s tired and hungry, and the test excuse is only respectable the night beforehand. (Seriously; my least favorite student this year was the one who, when offered the chance to scrub on a combined pancreas/kidney transplant, replied that it was early in his call night, and he wanted to get some rest. Unbelievable. So I scrubbed instead; I guess I owe him for that opportunity.)

Get some suture, and tie knots on anything – scrub pants, lab coat, drawer handles. Get good enough that you won’t be impossibly slow (reasonably slow is ok) if you’re offered the chance to tie something.

3. Fulfill your responsibilities. The surgical services run at a fast pace, and although it may seem like scut to you, the residents do count on you to do some things, and we appreciate your help. Retracting can get tiring and boring, but if you’re ever the one with the knife, you’ll know how much difference a few millimeters of angle can make. Writing notes at 5am is a chore, but your intern will love you for it, and you’ll learn from the regular contact with your patients (ok, so not so much when they’re sound asleep). So here are the basic responsibilities of a student on surgery: Round in the morning and write notes on the patients whose cases you saw yesterday, and any others you were assigned. (Do not be late for rounds.) Plan on scrubbing in for every case possible that day, and do your best to find out ahead of time what the cases are, so you can read up on them. The chief should be able to help you figure this out. Be present for attending rounds, if they exist on that service, and go to clinic if it’s expected. And finally, plan on doing postop checks and notes on your patients. This again may seem like scut, but you don’t know how many nearly-narcotic-overdoses, nearly-acute-renal-failure, nearly-hypotension, nearly-exsanguination episodes have been caught by careful postop rounds, not to mention all the other complications particular to a certain surgery. Unless specifically dismissed because it’s getting too late in the day, you probably shouldn’t leave until your team has made afternoon rounds. (I usually try to let my students go if this is going to run later than 6pm. It varies between hospitals.)

So yes, you will be working 12-14hr days, but you’ll be seeing things that you barely even heard about during medical school, and you can get a lot of hands-on experience. If you come prepared to work hard and learn, you’ll probably have fun (and also get started on the sleep deficit of the rest of your career; but there you are). 

Anyone have something to add?

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