How Can I Thrive on My Surgery Clerkship?

Benjamin S. Bryner, MD

Disclosures

September 08, 2011

Question

I really want to be successful on my surgery rotation and get a good evaluation. How can I do this?

Response from Benjamin S. Bryner, MD
Resident in General Surgery, University of Michigan Health System, Ann Arbor

This is my first contribution to the Ask the Experts column, so I will introduce myself. I'm a resident in general surgery at the University of Michigan. I am just finishing my second year and have another year on the wards before my research time, when I plan to work on projects related to extracorporeal life support, including an artificial placenta. I attended the University of Michigan for medical school, and I used to write for The Differential , a Medscape medical student blog.

How can you really flourish on a surgical rotation? I am writing from the resident's perspective. Ultimately the faculty's opinion is what matters on your transcript, but I would like to offer my own tips, and I hope you find them useful.

There are 2 types of medical students: those who want to specialize in some type of surgery, and those who complete a surgical rotation only because it is required. Their goals are different. Students who want to go into surgery will be more concerned with impressing the surgical faculty and doing well on the exam. These people may be looking for some kind of confirmation that surgery is the right choice.

It is definitely possible to do well on the rotation from either angle. I've had several terrific medical students who honestly said they had no intention of going into surgery (either they had something else in mind or were just sure they didn't want to step into the OR ever again). Those people (I hope) got the essence of what surgery is, and a good idea of when surgery needs (and does not need) to be considered. If they did, then I think the rotation was successful.

However, the person asking this question most likely wants to go into surgery, not merely survive the rotation before moving on to neurology or pediatrics. Most importantly, to impress the faculty, you obviously have to be well read on diseases and anatomy; most surgeons will not expect you to know the details of operative technique at this point. In clinic, you should know how to give a brief, linear presentation of a patient.

As far as getting along with the most mercurial of creatures -- the surgical resident -- I can offer a few tips:

Be proactive. The best medical students I've had are not content to follow me around, but they are asking how they can help and are running off to see a patient or get things ready for a bedside procedure without being asked.

Be vigilant. In the OR, students can offer another helpful set of eyes to detect trouble. For instance, students have pointed out that I've put a suture too far through the skin before I noticed it and have reminded me to order follow-up tests. I've been very grateful and have remembered it when faculty ask for feedback on that month's students.

Be entertaining. If you say 1 interesting or funny thing a day, people will remember you. Most of the third year of medical school is really about getting along with people, and surgery is no exception.

Ask thoughtful questions. This is an underappreciated art. As long as the operation is proceeding smoothly, you should ask questions that show you are thinking about what's going on and not spacing out and listening to the radio. I admit it can be hard to tell when the operation is not going well: time, blood loss, and cursing are not reliable indicators. It has more to do with the tone of the conversation in the OR. If in doubt, it's usually safe to ask if now would be a good time to ask a question about the operation. (I still do this if I'm double-scrubbing a bigger operation with a senior resident.)

Do as much as you are allowed to do. I have to include the caveat that I don't know how the surgery rotation works everywhere. The trend, however, seems to be allowing medical students to do less and less in terms of documentation and seeing patients independently. You may be allowed to do more or less than your peers at other schools or hospitals, but you should always do as much as you are allowed to do. If you're allowed to write notes, do it. If you're allowed to see consults yourself, do that and then write up as much of the history and exam as you can (either to enter as a note or to give your resident something to dictate). However, never let a resident convince you to do something you aren't allowed to do.

Regardless of the institution, a student who makes sincere, intelligent efforts to help the surgery team will always get a good evaluation. Residents will also be more likely to make time to teach if you are able to help them, or they may not. In those cases, be patient. At some institutions, surgery residents are difficult to get along with. I hope and believe that that's changing, and at my school the surgery residents were always respectful to me. If you encounter a surgical resident who is not helpful, try to put yourself in their clogs for just a minute: they're living inside a pressure cooker, caring for patients, answering endless pages, operating for hours, neglecting personal lives, and trying to remain compliant with work-hour restrictions. I'm not excusing bad behavior, but from a practical standpoint, you may have better luck if you treat them like you would a friend who's just cranky that day.

Finally, don't complain. It may feel good, but it never works.

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