Making Most of Surgery Rotations

Question

When rotating on a busy surgical service, how can I be helpful and show that I am interested without getting in the way?

Response from Sarah N. Bernstein, MD Resident, Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital, New York, NY

In the surgical subspecialties, physicians are usually busy from dawn until dusk, and you may find it difficult to find your place and understand the expectations of the rotation. Just remember that your primary goal is to learn and get as much exposure to the subject as possible. If it is not an area of interest, remember that this may be the only time in your career when you observe particular aspects of this area of medicine. Therefore, you should still try to see as much as possible. If you plan to pursue surgery as your specialty, this is your time to learn the basics and show your enthusiasm. I'm sure each teaching hospital is a little different, but here are some general pointers:

Morning Rounds:

• Always, always show up on time!
• Take ownership of your patients:
  • If you observed a surgery the day before, ask the residents if they would like you to come in a little early to see the patient and write a note.
  • If you feel comfortable, ask if you can present the patient to the team after you see them.
• Fill your pockets with syringes and bandaging supplies so you can learn to remove foleys and staples.

In the Operating Room:

• Ask residents about the schedule for the following day and try to read about the procedures and the anatomy so you will be able to follow the steps.
• Always introduce yourself to each patient and ask for their permission to observe the surgery. (It is not enough to stand at the bedside wearing your name tag!)
• In the first case of the morning, watch the residents set up and try to help them the next time.
• Learn basic knot tying at home or ask one of the residents to teach you so you will be prepared if the opportunity arises.
• It is great to ask questions, but make sure you choose an appropriate moment. Avoid asking when a complication has arisen or the team is in the middle of a complex portion of the procedure.
• There will be down time between cases, so bring a book!
• If you have to go to a lecture or are scheduled to be somewhere else, be sure to inform the resident in charge.

In the Clinic:

• Depending on your comfort level, you may observe a resident for the first few patients, but afterwards take the initiative and pick up a chart, then start doing a history and physical exam.
• Ask the residents or attending if they can look through the charts and find a straightforward patient appropriate for your level.
• When you're not seeing your own patients, follow as many residents as you can to observe different styles of interaction and learn procedures.
• One of the greatest challenges of being a physician is explaining complex problems to a person with limited medical knowledge. Observing someone else is one of the best ways to learn!

As I mentioned before, always keep in mind that you are a student of medicine and your primary goal is to learn. You are not expected to be a coffee fetcher or to perform like a resident. Read, be courteous, and show interest -- and you will do just fine!

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