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M3 Surgery Clerkship
Educational ProgramsResearchProgram for Global Surgery at VCUPatient Care at VCU HealthSurgery DivisionsSurgery DirectoryAbout the Department of Surgery at VCU

SHADOWING:
   M1 & M2 Trauma
   All Other Shadowing

M3 SURGERY CLERKSHIP:
   Contact Info
   Overview
   Program Components
   Goals & Objectives
   Educational Resources
   e-Curriculum
   Lecture Schedule (10.12)
   M3—Call Instructions
   Honors Advice

M4 SURGERY ELECTIVES

RESIDENCY PROGRAMS:
   General Surgery
   Oral & Maxillofacial
   Plastic & Reconstructive
   Urology

FELLOWSHIPS:
  Advanced GI MIS
  Burn
  Cardiothoracic
  Critical Care
  Surgical Oncology
  Transplant Surgery
  Vascular Surgery

ADDITIONAL LINKS:
   Simulation Center
   CME Office
   All About RVA

RESOURCES:
   Surgery Library Guide
   Surgery Intranet (GSW)

Ask the Honors

We would like to congratulate all students on their grade of honors on the Department of Surgery M3 Clerkship and wish them the best of luck in their future endeavors.

In order to help us in our continuous efforts to improve the program, we asked our honor students what advice they had for future students so that they too may succeed on the rotation.

dialogHere are their responses:

I approached surgery with the expectation of waking up early to spend long days in the hospital, meaning I packed snacks & was mentally prepared for coming in to round on the weekends. The key to surgery is being prepared for the next day by looking up the upcoming procedures & knowing the anatomy of the area (layers of the skin, specially named points) & a summary/step-by-step of the operation (good resources are Medscape if you can't find it in the surgery resources in Access Surgery via the VCU electronic Library).


Read about your surgeries the day before; take notes if you have to. Read about your patients; know their previous surgical history, allergies, meds, and any conditions that could adversely affect their recovery. Always smile, no matter what, no matter how long you've been there. Don't complain and don't be negative, a positive team member goes a long way, whereas a negative person can ruin the entire experience for everyone. Be on time, be prepared, be friendly. Practice your knots, as a third year you will have the opportunity to suture and tie and that's your chance to shine. Also, know your anatomy; be ready to get asked about landmarks and structures. Read Access Surgery before the case, read NMS before the lectures, and study while you can. Take a few hours each week to stay sane and go to the gym or cook or whatever. And have fun!!!

In terms of shelf prep, I found that between the weekly lectures, Qbank surgery questions, and reading through NMS surgery casebook, I was very well prepared for the shelf. I tried reading Pestana, which a lot of people swear by, and found it was too basic and simple and often I was just skimming. I did not stress too much during the week over studying; and instead, spent time each weekend reading and doing questions. This was plenty and helped me keep some sanity during the week. Plus, I really needed sleep and relaxation to be positive and happy each day. You do tend to have more time during the subspecialties, so use that block as a more intensive study block.

As for day to day, find something that you want to get out of the experience and focus on that. In the OR, you will get asked anatomy questions or general case related questions. Often they will keep asking until you stop getting things right. Always try and answer their question, even if you have no clue. Stop, think, and answer. Often I found that I actually knew the answer. That said, there were many days where I did not get a single question right. Don’t stress over this, just work on things as you go. You will often see the same case multiple times; make an effort to get the questions right on subsequent cases. Ask thoughtful questions, be engaged, it’ll keep you awake.

This is by far the easiest rotation to stab your classmates in the back and get a reputation for it. You spend a lot of time with these people, figure out a way to get along. I had an awesome team and it made surgery great. It also lets the residents be more relaxed since they’re not listening to a bunch of med students complaining about each other. The residents are tired, that’s about it. They’re not trying to be rude, ignore you, or anything else. Do what you can to help them out, even if its “scut” work. It gives you something to do and helps the day go by. It also helps the residents feel less stressed about their own work and gives them time to teach. This makes the entire day less stressful and more fun. It may take time for them to warm up to you, but make their life easier and they will repay you.


Be a team player. In surgery, more than any other rotation, I noticed that what each of us did personally affected the way they thought of the entire team. Luckily, I had a good team. Regardless, help out your colleagues and make them look good. Get there a few minutes earlier than you're expected to in order to run the list and make sure you have pre-rounded or talked to nurses to find out how your patients did overnight. This last bit of advice may sound a little funny, but sometimes it's best to stay out of the way. The interns and residents are so busy that they don't want to hear every little thing you do, even if it concerns your patients. I'm not saying to hide information about your patients, but try to be autonomous and help out your patients, then report to the intern information that is important for them to know about the patient. 

I think the key to doing well in Surgery is to be present, both physically and mentally, while at the hospital. Never say no to trying anything even if you have no idea how to do it, you are watched very closely and will be coached through it. I have probably the worst surgical hands in the world, poor depth perception and quickly drift into hypoglycemic coma if not eating every hour yet I was still able to do all sorts of cool stuff. None of the surgeons I worked with had high expectations for our recall of various bits of anatomy or procedural specifics, but would expect us to know about the disease we are treating, why an operation is indicated, and a little bit about the medical history of the patient where it would affect pre,intra, or post-op management. Be honest about what residencies you are considering and most will tailor their advice or factoid- spitting to suit your chosen field.

On rounds, quickly learn the names for the types of dressings and supplies that are needed and eventually be able to predict what will be needed for which patient. It makes the morning go faster and everyone gets to the OR that much sooner. Make sure you know your patients and their history inside and out, often the student is the one with the most knowledge about someone and if you prove yourself to be a trustworthy source of information, your opinion will be valued. As students, make sure you and your classmates are functioning as a team. Teamwork is the core philosophy of surgery and I think we are actually mostly judged on how well we function as a med student team and how well we integrate into the surgical team.

In terms of the board exam, pay attention during the lectures, it’s all on the test. I used Surgical Recall to quickly skim before cases. Pestana (every fact is gold) and UWorld were more than enough to do well on the shelf. I think this is probably the only board where I wasn't blindsided by a random question. Much of your knowledge is learned while at the hospital.


My advice for students hoping to get honors in surgery is to not try to get honors in surgery. Simply approach the material and patients with an appropriate level of interest and enjoy the process of learning something new - if you can't do this, reconsider medicine as a career (seriously). Get the most out of the experiences of 3rd year that you can (which is a very personal determination) so that you have no regrets when the year is over. Treat other students with respect and don't try to one-up each other - it's pathetic, immature, and very transparent. Offer support if someone is having a hard time. Say nice things about your fellow students, staff, residents, and attendings. Ultimately, be someone that you would want to work with.

Arrive early, anticipate your team's needs, work well with your fellow students, work well with your residents, be involved and engaged. You WILL be tired every day, but try to study some everyday! 

I was dreading surgery and had put it off until almost the end of the year, which meant I had only heard stories all year long about how bad it was going to be. Thankfully, it wasn’t nearly as terrible as I had made it out to be in my head. You will work long hours, but you keep very busy so the time goes by very quickly. The number one piece of advice that I have to give is: Do everything you can to help the team! Help out your other med students and don’t throw them under the bus, help your residents whenever possible, and help the scrub nurses/circulators in the OR with moving/prepping the patient as best you can (they will let the attending know if you aren’t being helpful and this does not look good). Being a good team member will make your life and everyone else’s just a bit easier. Secondly, it may be tough, but try to get a full night’s sleep. This may mean going to bed at 8pm, but it makes pre-rounding and early surgeries more bearable. 

As far as studying, you won't have all that much free time to study during the day. After work, you’ll be too tired to study most nights. Number one for studying: Read up on your cases beforehand! Depending on your team and how long they take to round, you may have 10-15 minutes before you need to go meet your patient. This is a good time to read over Surgical Recall (a must buy!) and learn some of the “pimping” questions. Whenever I had a few minutes throughout the day, I would read Case Files. Also, having Q-Bank on your phone is helpful, because sometimes you’re standing outside a patient’s pre-op room for 20 minutes waiting for the anesthesiologist to wheel them back, and you can work on a few Q-Bank questions during this downtime. Lastly, the night before the exam, read Dr. Pestana’s notes. I got probably 5-7 shelf questions because of that book that I would not have gotten otherwise. 


My advice is read the NMS case book and do as many practice questions as possible (Uworld, etc). Pastana was helpful as well, but by no means complete. 

Surgical Recall is NOT the best way to deal with pimp-questions. NMS Casebook is. Surgery is way more than the OR...it's about decision making. The way to be a stud and be sharp on surgery is to understand the reasoning. "Why are we taking this patient to the OR and not this one? Patient presents like "x"...what do you want to do next?" Recall is just quick facts. NMS casebook helps you understand the thought process. If you want to impress people, you've got to use your brain and think about the "Why"...remembering random facts are cheap and incredibly low yield.

Surgeons don't expect you to be perfect...they expect you to ADAPT. If you show that you can roll with the punches, can change behavior to become more efficient, are not afraid to be criticized, and show an honest interest to improve...you are impressive.

Focus on being a functional team member. Other clerkships want you to "pretend" to be residents, know when, and when NOT, to do this on surgery. Recognize your role as a med student and do what you can to be make an actual difference in patient care or team efficiency. Sometimes it requires you to act like a resident...most of the time it requires you to do things the residents are too busy to do.


I think the most important part of doing well in the surgery clerkship is paying attention to your team's needs and anticipating what needs to be done. It's great if you know the answers to all the questions your attending asks you, but first and foremost you need to work well with your team and be helpful. You may feel a lot of the work you do goes unnoticed, but if you show that you are self-sufficient, the residents will take notice and appreciate it. A lot of this has to do with how well you work with your classmates. I was lucky to have a great team at the VA and we really communicated well with each other and kept egos out of the way. Because we worked well together, there were fewer problems during pre-rounding and rounding. This made life a little easier for the residents and they grew to trust us and appreciate our help. There is no better feeling as an M3 to earn a resident or attending's trust, even if it's just to handle minor situations. 

Surgery is one of the toughest rotations of the year due to the early hours, high expectations of residents, and more pronounced hierarchy from student to attending that tends to intimidate students. The key to success is to be on time, be well-prepared, and be enthusiastic without being overbearing. Students should always be prepared with supplies (suture kit, 4x4's, scissors, tape, Q-tips, and abdominal pads) and should always be willing to help by taking down dressings and helping to re-apply them when needed. Be as thorough and neat with preparation of lists students are required to make, ensuring to update post-op day numbers and any tubes/drains the patient may have. Most importantly, always ask what you can do to help the residents and seek feedback during downtime to see how you can be of more service to them. For actual OR time, ensure that you ask about your cases the day before and split them up so you can read up on the case. Know why they perform specific steps and know the key anatomy (what could be knicked when they have to cut something out). The most important thing is to be enthusiastic and polite and to let them know that you will be more prepared next time and will try to improve if you do mess up. Enthusiasm will take you far, though, so smile even if it's 5am and you've started rounding or if you've been on your feet for 7 hours! And always thank the attending for allowing you to participate at the end of the surgery...manners are extremely important in surgery, from scrub techs to residents to attendings!

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