The Blog by Ziyad Nazem

Surgery 101: The Survival Guide

As I have currently been completing one of my final surgery rotations — I think it’s time I introduce my audience to the real side of surgery, not what you see in Grey’s Anatomy, or House MD. Let me start by saying, this will be one of your most memorable experiences in your clinical years — it may be the only chance you will ever have to see a liver transplant, an open-heart surgery, a laparoscopic gastric bypass, or even a simple appendectomy.

If you want it to be, it can be an unbelievable experience, but it can also be quite intimidating. In the end, think of it as an opportunity to learn some basic concepts about surgery that will benefit you regardless of which field you chose to go into.

To start, there are four basic parts to any surgery: rounds, the operating room, clinic, and call.

Rounds

On surgery, most surgical teams round twice a day. The surgeons spend most of their time in the operating room, and in the clinic. Thus, there are rounds before the day begins to set the plans for the inpatients, and of course rounds in the afternoon to follow up on what happened throughout the day. Rounds typically start between 6 and 7 AM and last for about an hour, during which time you see anywhere from 10 to 30 patients.

Tips & Tricks to Survive on Surgery Rounds:

You’re expected to follow 3 to 4 patients. You should know everything about why they are in the hospital, their relevant PMH, their work up, treatment, and recovery. I suggest you follow patients you have seen in surgery, or in clinic who were admitted to the floor.
You will generally be expected to pre-round on your patients, this includes gathering vitals and recent labs and evaluating your patients with a directed history and physical exam.
Try to be brief (shoot for 1 to 2 minutes) and organized. Try following S.O.A.P. format to keep organized.
Present vitals as Tmax, Tcur, HR, BP, RR, Sat or pulse ox, and the ins and outs (including urine output and drain output)
Know your diets, antibiotics, cultures, and IV fluids for all of your patients.
If you’re not presenting a patient, then help take down/change dressings — carry some dressing supplies with you such as scissors, gauze, and tape.
Remember to dress professionally for rounds, only wear your scrubs during post-call.
Keep everyone informed.

The Operating Room

Oh, the promised land! This is what surgery is all about. The OR can provide you with some very memorable experiences, from seeing rare unheard of cases, to getting a chance to suture at the end of the case. The key to getting the most out of every case, is being prepared. In the OR, teamwork is stressed upon — as it is extremely difficult to perform surgery without the right help. This begins from the time the patient enters the OR until the patient reaches the recovery room. You have many valuable opportunities for procedural experiences as a student, but just being present isn’t enough — you must be prepared to help.

Tips & Tricks to Survive in The Operating Room:

Be on time. You should arrive with the patient, or before they do.
Introduce yourself to the OR staff.
Try to meet with the patient preoperatively in the pre-care area — you can leave your pager number with the nurse, and ask to be paged when the patient arrives.
Wear the attire — scrubs, scrub hat, mask, eye protection, and shoe covers.
Take advantage of the OR, learn to place a foley, start an IV, help prep the patient. If there is something you would like to learn how to do, just ask.
Never take your pager in the OR, remove it before scrubbing.
Remember, you’re part of the team. Ask questions and be ready to help — they’re counting on you, but also understand there is a time for questions and a time to be silent.

Clinics

Usually, each service will have clinic at least one day each week — if you’re assigned to a particular attending, you should plan to be in clinic with that attending. Clinic is a great opportunity to meet patients before surgery, and it also provides a chance to follow up on patients through the entire process from start to finish.

Tips & Tricks to Survive in Clinics:

Make sure you dress like a boss in clinics. Sometimes you will be unexpectedly needed in clinic, so it is important to bring appropriate attire for clinic to work everyday.
Each attending has preferences. Ask the attending or the residents if they prefer you to see patients on your own or with a resident.
When seeing new patients perform a complete history and physical. You will present a complete H&P to the attending.
When seeing return patients perform a directed history and physical. Limit your interview and exam to the relevant information.
If you don’t know whether or not you should do something (i.e. take down a dressing), ask someone. Don’t just assume you should skip it or assume you should do it.
If the patient you see is going to be scheduled for the OR, ask a resident how you can help with the preoperative paperwork.
Try to be efficient. The clinics are often overbooked and you need to be fast, but thorough.

Call

Beep, beep! Yes, call is still a very real part of surgical training — and practice. Thus, you will be most likely required to take call. During call you see the urgent, and emergent cases that rest at the heart of surgery, it’s also a great time to pick up patients for your write-ups. Don’t hang out in the call room — make sure you have your own designated space.

Tips & Tricks to Survive on Consult Call:

Ask questions. Things can be very busy, but this is a great opportunity to learn. This may be your only chance to learn how to evaluate abdominal pain or other potential surgical complaints.
Take this chance to learn to write admit orders, read radiology studies, workup traumas, etc.

Tips & Tricks to Survive on Bed Commander Call:

If you get the chance, you will also be taking overnight call with the bed commander in the ICU.
This is an opportunity to learn about ICU issues you may not be exposed to on your rotations during clerkships.

And there you have it — Surgery 101, your definitive guide.