At a given instant everything the surgeon knows suddenly becomes important to the solution of the problem. You can't do it an hour later, or tomorrow. Nor can you go to the library and look it up.
—John W. Kirklin, 1963
John Kirklin was an Indiana-born cardiac surgeon best known for refining the heart-lung machine to permit highly successful cardiac surgery. His insight is that surgery is a field that is challenging, fast-moving and often requires serious but definitive decision-making. Consequently, the surgery clerkship is generally regarded as one of the more demanding rotations in medical school. It consists of multiple parts, one with a general surgery team and two areas of subspecialty surgery and 1.5 weeks on Anesthesia. If you are assigned to the Integrated teams you will be assigned to a University team for ~2.5 weeks and either Riley Peds surgery OR Methodist Trauma Surgery for ~2.5 week. As with the rest of the PEARLS, we hope this section will help to ease you into this rotation and offer some tips for success. Keep in mind that this section is by no means a replacement for the curriculum of the surgery clerkship. It is simply a collection of useful information that has been compiled by the students who have been there before you. Good Luck!
This section is a quick reference guide to things you need to know before starting your surgery clerkship. We recommend at least glancing through this part before starting your first day of surgery – it will help you not feel quite so overwhelmed.
The pearls are a more comprehensive review of key topics, though not as detailed as the review books. We advise you use this section are more of a starting point before turning to more thorough resources.
Advice from previous students
"Your grade is split evenly between the General Surgery rotation, the Subspecialty rotation, and your final exam. Advice for the final is easy: read pestana notes - easily the most high yield for the exam, that’s my opinion and the opinion of many before me. For the PDF URL, see below under Online Resources. For the General Surgery rotation, each place differs somewhat (in both your role and the hours you’ll work, although this may change from my year ‘13), but make sure you identify your role and own that role. For surgeries access info for the patient the day before (or morning of if you have some downtime) and make a notecard about that patient (MRN, hx, and plans for the OR) and read about the pertinent anatomy the night before (even if you just look at Netter for like 5 min, it may get you some pimp points). In the OR you may or may not be pimped, but try and anticipate both questions that may be asked and also learn the ways of the OR - make sure you introduce yourself to the scrub nurse and the circulating nurse, grab your gloves, and anticipate when to cut suture or hold retractors - the staff surgeon will notice your efforts and the resident will appreciate it and hopefully let you do more. Things are less predictable for the Subspecialty rotations, so look through this set of Pearls at the section you are in and try your best to get info from that."
"There is no best way to prepare for surgery unless you've had medicine first and that's the truth. So don't stress about this. You'll be alright. Use NMS casebook or pre-test surgery. Make sure you acted interested and read about surgeries beforehand--why you're doing the surgery, pathophysiology, anatomic landmarks. Also help out the nurses and have a good attitude. Be flexible. If you get yelled at, just know that that attending has most likely yelled at a billion med students before you and you are not unique...that's just how it is and you'll get through it. You may be surprised in the end and get a great eval; just keep working hard and don't let anything discourage you. Also, in those small groups make sure you're well prepared and speak up. Surgery types are typically more aggressive so speak up and make your presence known."
- Surgery Recall - the "anti-pimping" book. I was asked many questions straight out of this book. Not a good study book for the test, though.
- NMS - Great for the test, but long. Since you have 2 months, this is a good book to read. Has chapters on subspecialties as well.
- Case files - Good for very BASIC reading. Use only as a starter.
"I used NMS case files and thought it was decent. Surgery Recall is good for being prepared for questions in the OR, as well as knowing what is going on, but a little large for use for the exam. I like Pestana's trauma vignettes for high yield information."
The final exam: The best thing you can do on this rotation is for 1 hour every night study for the exam. While this sounds difficult after a 12-16 hr day, 1 more hour really isn’t that bad and it will pay off big time in the long run. During a 2 month rotation, 1 hr a day will really add up. The Pestana document (aka Kaplan Surgery) is really good to do quick light reading. It is by no means comprehensive. It will help you quickly synthesize some basic vignettes. I liked it because it was easy and quick to read. This is probably the most high yield for the time put in because while it is kinda thick, most of the pages with cases on them only require you to learn a handful of facts. Additionally, there are audiofiles which float around from student to student and can be quite helpful. NMS casefiles is also useful. It too gives short burst clinical vignette and helps you recognize how the questions will be structured. Pre-test is very broad and not necessarily specific to anything you will see on the test. However, if you do it (I had it on my phone and would do quick questions in between cases) I think it helps jog your memory about a variety of other specialties (medicine, peds, path, ect) and can be useful. It is not the most high yield thing. The NMS textbook is way to esoteric for you to need to pass the exam. I think this is much more of a surgical intern, or definitely a surgical sub-I book. It has substantial amounts of info that won’t be on your test or needed for wards. Unless you want to be a general surgeon, I don’t recommend it. Surgical Recall may be good for pimping. My attendings at Uni A team asked very few things out of it so I didn’t use it much. The audiofiles that come with this text might be helpful as well.
Prepping for cases: I recommend simply asking what the resident thinks you should know. This is a great start, especially when on sub-specialty because different specialties have their own specific text (ex: ortho – Hoppenfield). Surgical anatomy is different that gross anatomy. It is all about the approach and knowing your landmarks. While Netter can be helpful, ie re-learning the branches of the celiac plexus before a big open laparotomy, it isn’t the best thing for learning surgical anatomy. Always ask what approach they will be taking and research that the night before.
The wards/OR: this is general advice for all specialties but hold especially true for surgery – the more you prove to them that you can do, the more they will let you do. The most important thing you can do both on the wards and in the OR is show everyone around you that you are competent. While this is hard, it will pay off so much in the long haul. Not only will you get amazing evals but you will get to do cool stuff (closing, using the ortho drills, taking out gallbladders). Having a take-charge attitude is a big plus. While you have to watch this with certain attendings, never be afraid to make a "safe move". If the resident is tying a knot, ask for suture scissors. If you know they always close w/ 4x4s and metipore tape, make sure that is ready to go. If you are unsure, ask. "Do you want me to close so you can go write orders?" Don’t be afraid to ask for things to help out the case. By anticipating the next move (ie the resident is tying a knot and you ask for suture scissors) it really shows you are engaged in the case and actively thinking instead of being a human retractor. On rounds, always carry things with you – 4x4 gauzes, scissors, suture removal kit, staple removal kit, mastisol, tape, ect. And never be afraid to use it! Always answer with confidence. Being unsure of the answer is the same as not knowing it to a lot of surgeons. Being wrong won’t be counter acted by saying "I think". Answer the questions firmly and if you turn out to be wrong, go read up on things that night and make sure never to make the same mistake twice. You can’t have all the answers but you can learn from your mistakes."
- Pestana Notes PDF URL: http://www.uky.edu/~amwill7/Pestana%20SURGERY%20REVIEW.pdf
- Surgery 101 - podcast you can get on iTunes for free; really great resource for gen surg and subspecialties, usually 10-20 min lectures that go over important info for the topic at hand
- ACS Surgery: Principles and Practice (available through Lilly Library website) – read about procedure
- MedlinePlus - http://www.nlm.nih.gov/medlineplus/surgeryvideos.html - videos of almost all procedures
Suturing and Knots
- Boston University- technical-training/basic-knots-sutures
- Ethicon Knot Tying Manual– call for free supplies
Text Resources: Review Books
- Surgical Recall(Recall Series). If 1 book is essential for the surgery clerkship, this is that book. Buy it, read it, and then read it again. Also available in pdf format.
- First Aid for the Surgery Clerkship Very helpful and manageable mid-week reading, not all inclusive, but pertinent.
- NMS Surgery. Dense and detailed, but the questions are useful.
- Blueprints Surgery: Principles and Methods. Not enough detail, but again, good questions, similar to those on the shelf examination (ie, long!).
- Schwartz Principles of Surgery Reference Text: , ACS Surgery Principles & Practice
Text Resources: Question Books
- Pretest Self Assessment and Review; These questions provide good coverage of topics seen on the shelf, but the stems are shorter than on the real examination. Now and then an answer is marked incorrectly, but the explanations are accurate.
- Case Files: Surgery (Lange Case Files) VERY High yield, with detailed answers. If you are out of time, and simply cannot study, this is the one book that will save you from doing poorly on the shelf exam.
Tips and Tricks
Interested in Surgery?
If you have questions or are interested in surgery and want to get connected, contact firstname.lastname@example.org. This is the email address for the Surgery Student Interest Group. The purpose of this group is as follows:
"The surgery student interest group is an organization of students interested in pursuing a career in general surgery or surgical specialty. Our goal is to inform fellow medical students of the rewarding lifestyle and career in surgery as well as presenting advancements in technology in surgery via informative lunch meetings. We also help celebrate the culmination of our fellow four year students going into surgery by hosting a post-match day party in the spring. This allows a forum for the senior students to share ideas with the juniors"