If you read my End Of Rotation Review of General Surgery (aka a synopsis of my experience), you know that I not only had an excellent educational experience, but I also made some friends along the way. Know that hospitals and institutions vary widely in culture – use any advice I give with extreme discretion. Have situational awareness. Stay out of the way. Don’t do anything stupid. Try to be helpful where you can. And have some fun.
Here are my 9 rules to honoring your general surgery rotation.
1. Be Kind and Respectful to Everyone
The most basic advice on this list, yet often overlooked. On your rotations, you’re not going to be remembered by the number of pimping questions you got right; you’ll be remembered by how you treated others and how you assimilated with the team. No one is below you. Not the nurses. Not the scrub techs. Not the orderlies. They’re all people the same as you.
So use those manners momma taught you. Smile and say good morning, even if you’re tired and don’t want to be there. Show up on Mondays and ask, “how was your weekend?” Simple stuff like that. When they realize you’re a genuine and kind person, they’ll look out for you. The scrub techs will make sure you get a good spot at the table. The nurses will help you in any way they can. The CRNAs/Anesthesiologists might even let you intubate. As a rule going forward, the better you treat others, the better your experience will be.
2. Help in Any Way You Can
You’re a medical student and you’re not going to be performing surgery, but there are many ways to make yourself useful in the OR. Perhaps the best way to endear yourself to the surgical team is to help with the little things. After a few days, you’ll get a feel for the process of prepping a patient. For starters, here are a few things you can do to help:
- Help transport the patient to/from the OR. The nurses will usually push the bed, but simply holding the doors will show that you want to help.
- After the patient is moved to the table, take the hospital bed and wheel it out the the hallway for the orderlies to grab.
- Ask the patient if they are cold and would like warm blankets (pre and post-op)
- Offer to get your gown & gloves for the scrub tech.
- Put SCDs on the patient’s calves and plug them in.
- Place Foley (nurses are happy to teach you proper technique)
- Shave, clean and prep the surgical site
- Clean stuff up
- If a resident is closing, offer to approximate the wound and/or man the scissors
- Help transfer the patient from the table to the bed
3. Make Your Residents Look Good
Surgery residency, as you know, is a grueling gauntlet that lasts 5+ years. Make the residents’ lives easier. Ask what you can do to help and don’t just say it as a formality. Even if it’s menial scut work. If you can demonstrate that you truly want to help them, they’ll help you. Although you shouldn’t offer to help for the sole purpose of personal gain, they might just send you home early to study.
You’re with these surgeons for maybe 2 months. The residents are stuck with them for years. Do not answer a pimp question if the resident is in the room. Even if they don’t know it and you do. The surgeon won’t give a damn that you knew the answer to some random trivia question ten minutes after you answer, but they might give the resident a hard time for not knowing. And that’s not cool. If a pimp question is directed at you and you get the answer right, here’s what you say: “[Insert resident’s name] just taught me about this before the case”. Memorize that gem. You and your resident will look good.
During a case with the most malignant surgeon at the hospital, the resident was being belittled and told how stupid he was. The surgeon then directed a question at me. I knew it and answered correctly, which prompted the surgeon to say, “even the damn med student is smarter than you” to the resident. I then replied, “actually sir, [resident] just lectured me about that before the case”. He hadn’t. But that didn’t matter. The surgeon had no response. And after the case the resident’s first words to me were, “I love you, bro”. After that moment, any time I was asked a pimp question, the resident would try to mouth the answer to me and steer me in the right direction.
4. Always Be Reading
Spending your downtime flipping through Instagram and reading Twitter might be a nice escape for a few minutes, but your time is extremely valuable on surgery rotations. You usually won’t have much time to go home and study, and when you do, you’ll be tired. Nothing wrong with reading UpToDate or hammering out some UWorld questions, but appearing glued to your phone isn’t always a good look.
Pestana’s Surgery Notes is the perfect text to flip through during downtime on your surgery rotation. While not comprehensive, it’ll give you a solid base of knowledge, the questions in the back of the book are helpful, and it fits just so perfectly in your white coat or the back pocket of your scrubs. PLUS, you’ll look smart. And that’s what it’s all about, right? Several surgeons who saw me reading Pestana’s made comments like, “oh I remember that one from my med school days!” (you can purchase it here)
5. Know About Your Attendings
If you have no interest in surgery, go ahead skip this one. But if you really want to make a good impression, do your homework on the surgeon you’ll be working with. It’s human nature to feel good when others are interested in you.
For example, there’s a well-respected plastic surgeon at my hospital. Before the first time I stepped into his OR, I introduced myself and asked if it would be okay for me to join him on his case. He obliged and we talked for a few minutes before starting. He asked me some standard questions and in turn, I asked, “you did your general surgery residency at X program and your plastics fellowship at Y program, correct?” He seemed a little shocked and replied, “So you’re interested and you’ve done your homework. I’m impressed”. After a few more minutes of discussion, he said, “you’re polite and you’re interested. You get an ‘A’ for the day”. After that first meeting, he sorta took me under his wing and invited me to come into join him whenever I’d like and encouraged me to do a full rotation with him.
Plus, many surgical subspecialties are small fields… Say for example you want to do urology and there are four urologists you rotate with. Find out where they did their residency, because they may have connections and could possibly put a good word in for you someday down the line. Something to think about.
6. Don’t Be Afraid to Get Your Hands Dirty
You won’t get much out of your surgery rotation if you just stand around twiddling your thumbs while daydreaming about your bed. And the residents/physicians often won’t push you to get involved unless you show initiative. The key to getting involved is to demonstrate interest and simply ask. Take your opportunities when they come. And don’t do anything too stupid. It’s obviously awkward as hell the first time you do anything (e.g. the classic: hold the camera still while the surgeon is leaning their entire bodyweight into you). But the more you work with a particular surgeon, the more comfortable you’ll get. You start to get a sense for the procedure and you’re able to anticipate their next move. And once you build rapport with a surgeon, you’ll gain some comfort and trust and they’ll let you do more.
For example, if you can hold the camera and suture the small trochar incisions on a lap chole, they may let you be first assist on a parathyroidectomy and allow you close the 4 cm incision on a patient’s neck. Even if you’re nervous, just get in there and do it. That’s how you learn.
7. Learn to Suture
Holding the camera and retracting aren’t difficult tasks. I think the one way to truly shine and show some technical prowess on a surgery rotation is to be a beast at suturing. Unless you have ice in your veins like Tom Brady in the playoffs, you’ll be shaky your first time or two. That’s okay. Just do your best and get those first-time jitters out of the way. Then get a suture kit to work on at home and practice, practice, practice. Make it your goal to be the Mariano Rivera of closing incisions. Shoot for the moon.
If possible, seek out cases where there won’t be many residents. And if you abide by rules 1-3, you may even get to the point where a nurse or resident will shoot you a text saying, “hey get over to OR 12, we’re about to finish up and you can close”. Take every opportunity and try to get a little bit better every day. It’s pretty much your major opportunity to impress.
8. Be Humble
I did well on Step 1, I’m confident in my ability, and I know in my heart that I’ll do whatever it takes to be a great doctor someday. But when I started surgery, I didn’t know anything. Sure, I had an abundance of USMLE-level minutiae floating around in my brain, but not much practical knowledge. Hell, I hardly knew how to scrub properly.
I know when to be serious, but my soul thrives on humor. On my surgery rotation, I learned that the trick to getting people to warm up to me was to make fun of myself before someone else could.
When I started, I’d say something like this to nurses: “hey I’m the new med student and I legitimately know nothing” followed by “can you tell me about this”, “show me where that is”, “teach me how to place a Foley”, etc. etc.. Don’t try to be a comedian, but I found that this brand of self-deprecating humor was very endearing to the staff. It was always good for a laugh and in turn the nurses/staff always had my back and did whatever they could to help me. They knew it was in jest, but they said it was so relieving to work with a med student who didn’t take themselves too seriously. To my surprise (and I mean that), they said many medical students they work with are arrogant and act ‘above’ them.
Come to terms with your ignorance and be humble. My old man was a vascular surgeon so this stuff has been drilled into my head. In fact, he told me he only failed a student once, ever, because that student was intolerably arrogant and rude to nurses. No one expects you to be some know-it-all surgical prodigy day one. Your goal is to be trainable. Your goal is to be coachable. And your goal is to improve every day.
This brings me to my final and perhaps most important bit of advice for surviving surgery without a mental breakdown…
9. Don’t Take Criticism Too Seriously. And Have Fun.
Surgeons are often stressed. They’re tired. And they face significant pressure to perform their best every time they go to work. It’s the nature of the work. But they’re people. Most like to joke around. And guess what, you’re at the bottom of the totem pole so you’ll often be the butt of jokes. It doesn’t mean they hate you. It doesn’t mean they think you’re an idiot who will amount to nothing. In fact, I discovered that the more they tease you, the more they like you.
It actually reminded me quite a bit of high school football. When you’re a freshman/sophomore, you’re going to be “hazed”. The seniors will make you carry their pads. The seniors will make you go to the back of the line to wait for a sip of water during a hot summer practice. It’s not malicious. It’s just people having fun and humbling you. If you can put your head down and take a joke, you’ll be friends with the upperclassmen and respected by the end of it.
That’s how surgery is, which I feel may sometimes be misconstrued as malicious. Often, it’s simply harmless fun. For example, on my first day, I took an extensive amount of time to close some simple incisions (first time jitters). The surgeon made fun of me and I embraced it. After he knew I could take his jokes, they kept coming. A few weeks later my attending pulled me aside and said, “J, [surgeon] really hates medical students but.. uh.. he said he really likes working with you. So keep doing whatever you’re doing”.
Now, of course, there are some true scrooges who aren’t being playful when they make unkind comments to the lowly med student. That’s okay though. Listen, look them in the eye, be respectful, and take the criticism constructively. If the criticism was directed at something you can improve on, make it your mission to work harder and impress them the next day. If it was a lack of knowledge, read up on the topic. If you suck at suturing, practice on a suture kit all damn night if you need to. If they were just being a jerk without educational objective, shrug it off and chalk it up to them having a rough day/year/life.
At the end of the day, I feel that this is why I had such a phenomenal experience on my surgery rotation. Work relentlessly to improve in any way you can, but don’t be too hard on yourself when you come up short. We all do at some point. Know when to be serious, but also know when to laugh and take a joke. Understand that nurses, residents and physicians are all humans who like to smile and have fun. And always – be kind, be respectful, and be humble. Do these things, and you’ll thrive. Best of luck.
Check out Part 3 in my Surgery Series: