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Student Recommendations: The shelf has focuses on medical management of surgical patients, and thus resembles the Medicine shelf (but you can still do well even if you havent done IM yet). There is very little, if anything, on surgical techniques. Make sure to read general notes, like Kaplan or a textbook to cover the management of patients on the floor. Most recommend: Review Source +Case Files +Questions What Students Said... Textbooks - Essentials of Surgery (Lawrence) Review Books Surgical Recall Easy to follow and organized well, but lengthy. Use to review difficult topics. Read first chapter weekend before rotation. It describes the names of all the tools, what you should do in the OR, etc. Great to have in your pocket for the floors, but not sufficient for the shelf (see Fill Your Pockets section). A good reference/overview for the SHELF, but not sufficient alone. The vignettes (which reiterate the notes but in a Q and A form) are especially high yield. Great review of important topics, but should supplement other material (not enough details). Try to read twice with rapid read through second time 2 days before test.
Felt like questions were similar to SHELF. Questions were useful, but theres usually only about 200 Surgery questions. There were also more ortho questions than on the actual exam. Lab values, helpful equations, and templates for notes. Great to read before going into a case, as you will likely be pimped on some of the questions listed. Also, a good quick overview before lectures. Though it will help you on the floors, it is not sufficient for the shelf. Jot down pearls of wisdom and notes from the day. You can also write down assignments/tasks and stay organized.
Pay attention to what your team may be looking for during rounds (ex. dressing changes materials, suture removal materials, etc.). It just helps make rounds more efficient for your team rather than always having to scramble to find materials.
between cases (could be a complicated case that lasts for 5 hours). Nobody will tell you when they are getting ready to take a patient from the pre-op room to the OR, so you have to watch the time, and make sure you are near the patient. Make sure you have reviewed the indications for the surgery and the relevant embryology, anatomy, pathophysiology, and management before you go into any case. If you have extra time, read about the steps of the procedure, which will help you predict the surgeons movesthis allows you to provide better visualization of the field. Ask thoughtful questions in the OR, especially questions about technique. Never ask questions during a critical part of the case, or if things are going poorly. Ask to be taught to suture, etc. Keep bandage scissors, needle drivers, and sutures with you for practice when youre tired of reading.Surgery is all about style. Palm your needle driver. Suture like youve been doing it for years. Being vocal, confident, and hardworking is especially important in surgery. On a busy service, it can be easy to disappear, especially on call. Residents will notice, so make sure you are always available in the OR and the ER. Also, always be nice to the scrub nurses!! You can usually scrub into any interesting cases, but if you are going in during the middle of a case, put a mask on, go into the OR and ask the attending if it is okay, and then grab and open your gloves (scrub nurse will tell you where) before you scrub in. Rules in surgery: do NOT go into the OR hallways w/o covering your hair (usually red lines on the floor indicate where these start). Never go into an OR w/o a mask. You must always scrub in if you are going to be involved in the case (you will be shown how). Before you scrub in, always pull your gloves and gown for the scrub nurse (again , ask how). When you are scrubbed in, try not to contaminate yourself or anyone else. If you are planning on operating on a patient, accompany them from the pre-operative room to the OR (if you ask, they will let you put in Foleys, etc in the OR). After a case, always accompany the patient to the recovery room.
everyday, which can be difficult because you can be very busy both months. Even if you have not had IM before Surgery, you can still do well on the test if you manage your time appropriately. Given your time crunch, lectures are a great time to learn/consolidate information. Since there is a good chance you will be pimped during these lectures anyways, try and read for lectures and pay attention. This will go a long way, as will being prepared for your cases. The majority of the exam will focus on general surgery. There may be a few questions on subspecialties, but they are not the main focus of the test.
Childrens Oakwood/VA
HFHS
Beaumont
St. Johns
Providence
scrub into any surgery you want (not just surgeries with your team). Great teaching from both residents and attendings, especially if you show interest. They have a surgical learning center with workshops to teach students tying and stitching etc. Your hours are from 5:30ish am to 5-6 pm. You are on call every 4 nights for the first 5 weeks, with 8 calls total. You will likely see a wide variety of trauma on call. Final 2 weeks of rotation consist of electives. Thoracic, plastics and ENT are great services with lots of teaching, but long hours. Peds surgery is great too. Moderately busy service w/a good amount of floor time. Residents very friendly, and free food. Hours some of the best. However, it may not be completely representative of a true Surgery residency, so for people who are interested in Surgery I would suggest doing a SubI or elective downtown to get the true experience as far as hours and call, etc. For everyone not interested in surgery, it was great. Hours were 6am 5:30 pm (no earlier, no later). No weekends, unless on call. Call was once a week, overnight. It's kind of hectic at first b/c you're not on call with your team, so you have to contact the residents on call to give them your pager for any consults. Do NOT try and skip out of call; the residents will notice even though it seems like they don't. You respond to all of the traumas overnight. We rotated through 4 areas: 2 weeks service 1 (general surgery), 2 weeks service 2 (general surgery, but mostly laparoscopy), 2 weeks vascular, 2 weeks of subspecialties (where you just show up and go to whatever surgery sounds interesting on the board). We got meal cards (which were technically supposed to be used just for call, but worked all the time; although, I hear they're going to be more strict about it this year). There are 2 students per team. The services were pretty busy, but there usually was time to study in the afternoon between consults. St. John has some wonderful WSUSOM alumni that are excellent to work with in the OR. Dr. Mittal and Dr. McKendrick will be doing your evaluation, even if they have talked to you for less than 5 minutes for the duration of the 2 months. Become friends with whoever has access to the dissecting lab (it may be the ortho residents). Get in the dissecting lab so that you look good in the OR. Keep bandage scissors, needle drivers, and sutures with you for practice when youre tired of reading. On Wednesday mornings the residents are in conference.
Useful Formulas
See Orange Section of Maxwells: -Anion gap: Na-(Cl+HCO3) -Fractional Na Excretion: (urine Na x serum Cr)/(serum Na x urine Cr) -Maintenance Fluids: 4mL for each kg 1-10 + 2 mL for each kg 11-30 + 1mL for each kg>30 -Corrected Na: Na +[ (glucose-100) x .016] -Aa Gradient: [713xFIO2)-(PaCO2/0.8)]-PaO2 -ABG Rule: change in 10mmHg PaCO2 = change of 0.08pH -Osmolality: 2 x Na +glucose/18 +BUN/2.8 -Body Water Deficit (liters): [0.6 x wt (kg) x (patient Na-normal Na)]/ (normal Na) -Creatinine Clearance (GRS estimation): [urine Cr x urine volume (mL)]/[serum Cr x time (min)] [(140-age) x wt (kg)(x0.85 for females)]/[72 x serum Cr (mg/dL)] -Corrected total calcium: [0.8x (normal albumin-patient albumin)] + Ca -Mean Arterial Pressure: diastolic BP + [(systolic BP-diastolic bp)/3]