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.

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So as I wrote in my previous, and first, entry to my “End of Rotation Review” series, family medicine was super chill (click here to read it). My attending was very empathetic to the med student experience and ensured that I had a good time during my month with him.

During my last week, he said to me, “are you ready to get your ass kicked by surgery next?” Most med students dread surgery as it’s notoriously known as an arduous, soul-crushing experience. Despite being pretty sure I wanted to go into a surgical field, I was a little bit intimidated. It’s natural. I had shadowed a handful of surgeons in the past few years but only scrubbed once before. As a first year med student fumbling my way through the foreign land of the operating room, I was kicked out of the procedure for breaking sterile field twice. Not my finest hour.

After showing up on my first day dark and early, I waited to meet the educational coordinator person (idk what her title is) who didn’t arrive until forty-five minutes after we had planned. After a brief tour of the O.R.’s, pre-op, PACU, endoscopy suites and all that jazz, I eventually arrived at my attending’s office, sat down and discussed the expectations for the rotation. “Do you know what you want to do yet?”, he asked.

As always, I like to keep my answer to this question relatively vague (i.e. if you’re on pediatrics, hate pediatrics, and would rather quit med school than pursue it as a career, you keep that to yourself and say you’re undecided but interested in what every specialty has to offer). However, it was surgery, and I want to do a surgical subspecialty. I am still remotely considering anesthesia as well. So I conveyed this to him.

He outlined the plan:

“So recently we’ve decided to start doing something different. You’re going to do whatever you want. You are not going to be tied to me or any other attending. You have the freedom to make this rotation yours. If you see something on the schedule that interests you, ask if you can scrub in. You pay so much money for every day you’re here and you have so little time to explore and figure out what you want to do for the rest of your life.”

These were his terms. My grade would be determined by comments from surgeons, residents and other staff. As long as I logged enough bread & butter general surgery cases (lap choles, appy, hernias, etc) and worked hard, I was given full freedom to spend my time with whatever specialty, surgeon, and procedures caught my interest.

Again, I struck gold.

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The two months (or whatever) of the autumn season is probably the only time in the calendar year I can say I’m actually not jealous of those who live in more stable climates.   I mean, just look at those colors – pumpkin orange, marigolds and bright red. It’s beautiful, man. Spooky season. Football and chili. Cozying up with a scary movie. Crisp weather and cool fashion. Ghastly decor and candy that we don’t need. Memories and music. Something about the fall is so introspective, nostalgia-inducing, and eerily atmospheric.

This aint your typica fall playlist full yawn-inducing acoustic indie songs tailored to the Pumpkin Spiced Latte crowd.   Certain songs, albums, and even particular sounds are associated with the crisp cool air of the autumn season.

Here’s a collection of my favorite songs that perfectly capture the fall atmosphere. (click the song titles for a link to each song)

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Another day at the office.

Snooze on the alarm clock as many times as you possibly can. Quick shower. Get dressed. Lace up the oxfords. Burn your tongue on cheap coffee. Fix your tie in the car mirror before walking in.

Another day at the office.

Say good morning to the staff. Make small talk with the attending physician. See some patients. Present them. Get asked, “well what do you think? What should we do?” Trepidly reply. Get it wrong. Feel stupid. Get the next one right. Feel smart. Here’s your cookie for the day.

Another day at the office.

Patient after patient. Well check. Med follow up. Ice and ibuprofen. Antibiotics. You’re fine. Refer to ortho. A day in the family med office. A fine-tuned machine with the health care tyrant’s corporate logo plastered on every wall, white coat, and welcome mat. The TVs in the waiting room no longer play the news; rather a 30-second loop of stale advertising from our overlords.

Lunch time is approaching. See patient in room three. Do the little half-hearted “doctor knock” on the door as you’re opening it. Goooood morning, I’m Jsoze and I’m a third year medical student. I’m just going to ask you a few questions and do a quick exam then we’ll get the real expert in here. Chuckle chuckle. What brings you in today?

She was in her late twenties. I think. Maybe thirty. She was dressed in fashionable clothing. Diamond ring on the left fourth digit. Though well put together, she appeared to have malaise. Perhaps she was ill. She said, I am depressed.

Then tears welled up in her eyes.

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Third year began with the familiar anxiety that accompanies each transition in life. In my case, the transition from sitting in my apartment studying constantly to the clinical environment. It’s truly amazing how in the span of a few weeks away from medicine, you can go from feeling like you know so much during dedicated to feeling like a complete idiot when you show up on day one of your first rotation.

While I’m currently on surgery, I started with family medicine and I thought it’d be a good idea to write a little review of each rotation after completion. I’ll include comments about the rotation, my experience/strategy for studying for shelf exams, as well as memorable quotes and interactions (inspired by the “overheard on X rotation” posts on Reddit).

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I have some free time today so I figured it’d be a good time to finally write this post. After spending months alone behind a computer screen, sitting down at my laptop is my least favorite activity. It’s too nice out. Anyways..

Score: > 250

I’ve chosen to omit the exact score for the purpose of anonymity and also because I’ve grown tired of the neuroticism I see on the internet. It’s between 250 and 260. Could be on the high end, could be on the low. Doesn’t matter. As an elder recently reminded me, board scores are the gateway to an interview. The rest, the you, determines where (if) you are ranked, and ultimately where you match.

(Simply glance at the 2018 NRMP Program Director Survey to see what I’m talking about)

Before I dig into my preparation, let’s get a few things straight.

First, what worked for me may not work for you. Like any advice you read on the internet, absorb what you feel is good information and ignore the rest. Nobody is infallible. There are multiple routes to success. I would go as far to say that UWorld is the only resource you absolutely cannot do without.

Second, don’t define your success by an arbitrary number. You don’t need a 250. You don’t need to go into a competitive specialty. Leave your ego at the door, and gravitate toward what you enjoy. Not what will impress whoever it is that you’d like to impress on match day. One person may be disappointed with a 240, while it may be your dream score. And there is nothing wrong with that. Forget about everyone else; you’re competing against yourself. Everyone should strive to do as best as they possible can on this exam, but remember, please remember that the three digit score can vary a decent amount depending on how you perform on actual test day and which 280 questions they generate for you. Learn to love yourself. This test is a game and it should never determine your happiness. Work as hard as you can. Beat the test. And move on.

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Sometimes I feel weird writing this stuff on here. But I pay for the domain so I guess I can write what I feel. I am not some infallible medical school prophet. I am just your medical school classmate. If you’d like to read a post of my morose complaints and reflections, continue. If not, no worries.

While this post is highly personal, I do believe there are lessons that can be extracted by all. This is simply something I’ve needed to get off my chest. My second year of medical school was the most difficult of my life. With deaths, a break-up, and pure social isolation with Step 1 looming around the corner, it was a tough year for me. I can smile now that it’s over, but it’s always important to reflect.

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Yesterday I binged the entire first season of Wet Hot American Summer on my couch. My mother cooked ribs on the grill. My brothers were in town. Last night, I sipped beers, laughed very hard with friends, talked to cute girls, and smiled.

I have smiled more the past two weeks than I had in the past 6 months combined.

I hadn’t smiled much at all since starting my second year. With deaths, self-induced isolation, a break up, and Step 1 looming over my head – it was a tough year for me. I’ll write more on all of this is my next post, but for now I want to send a message to anyone currently entering their second year of medical school. You may read this and scoff, but perhaps someone will read this and learn from my mistakes. This is my message in a bottle. I hope someone who will need it in the future finds it.

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