How to Ace Your Surgery Rotation

Karen Horvath, MD, FACS

Professor of Surgery
Residency Program Director
University 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 Knowledge
What you learn is
mostly dependent on
you
Requires YOUR
active pursuit of
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?
Interns 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 youll do something & not
come through
See a problem & not tell resident
Cause a delay in care
SURPRISE!
Practical Tips
 SIE
Syndrome of Inappropriate Enthusiasm

Displays of useless energy akin

to entropy
Aka Smoke blowing
Includes brown nosing

Substitutes for hard work

 SIE
Syndrome of Inappropriate Enthusiasm
Includes back-stabbing
Some kings stand taller by
making their subjects kneel
(an illusion)
Dont promote yourself by
stabbing others
Obvious even when subtle
Support your colleagues
Be seen as a team player

You dont 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. Youll 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
Dont disappear people notice
Notify someone
Mid-rotation, ask for feedback
 Summary
To get the mostgive
the most
People notice & the rest Patient
falls into place
Dont worry about
competing
Actively participate in all
functions of the team
Most of all.Be kind
 Bruce C. Gilliland, M.D.
Professor of Medicine
Division of Rheumatology
Professor of Laboratory Medicine
Adjunct Professor of Microbiology
American College of Rheumatology Master
1931 - 2007

If Id known what it was like to be a patient,

Id have been a much kinder doctor.
Bruce Gilliand, MD