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How to Ace Your Surgery Rotation. Karen Horvath, MD, FACS Professor of Surgery Residency Program Director University of Washington. Objectives. Goals of rotation Role as student & ‘performer’ Insights into the other side Practical tips from UW. What are your goals?. Goal #1.

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How to ace your surgery rotation

How to Ace Your Surgery Rotation

Karen Horvath, MD, FACS

Professor of Surgery

Residency Program Director

University of Washington


  • Goals of rotation

  • Role as student & ‘performer’

  • Insights into the other side

  • Practical tips from UW

Goal 1
Goal #1

  • To learn as much as you can

    • What you learn is mostly dependent on you

    • Requires YOUR active pursuit of knowledge


Knowledge in surgery
Knowledge in Surgery

  • Experiential = active participation

    • Hands-on, concrete

    • Changing dressings

    • Writing notes

    • Collecting labs

    • OR & clinic

  • Surgical concepts acquisition

    • Reading for patients

    • Prep for OR

    • Studying for test

    • Pub Med searches ad infinitum!

Goal 2 for your surgical rotation is to make a contribution over and over and over again

Goal #2 for your surgical rotation is to make a contribution – over and over and over again.

Goal 3
Goal #3

  • To obtain an outstanding ‘performance’ evaluation

    • You are performing

      • ‘Deans Letter’ = MSPE comments

      • Clerkship grade

      • Letters of recommendation

    • Know your audience!

      • Attendings, residents, nurses, patients & families

Who is your audience
Who is Your ‘Audience’?

  • Surgeons are…..

    • Detail-oriented

    • Direct

    • Concise

    • Practical

    • Logical

    • Linear

    • Efficient

    • Organized

    • Committed

    • Multi-taskers

    • Type A (perfectionists)

    • Strong work ethic

    • Awesome


  • Value patient ownership

    • Attached to patients in unique way

    • Bond of trust from surgical event

  • Value ‘appropriate’ initiative

    Surgery is a team sport!

The interns residents as your audience

The interns / residents as your ‘audience’.

What are saboteurs
What are Saboteurs?

  • Intern’s mission:

    • Take good care of patients

    • Prevent problems & complications

    • Facilitate care (get pt home ASAP)

    • Get the work done efficiently

    • Look out for team members (pain prevention tactics)

    • Look good in the process

  • Saboteurs are people who unwittingly try to kill your patient, your mission – or you!

No suprises please
No Suprises Please!

  • Potential saboteurs

    • Medical students

    • Other residents

    • Nurses

    • Faculty!

  • Methods of operation (med studs)

    • Not being 100 % reliable

    • Say you’ll do something & not come through

    • See a problem & not tell resident

    • Cause a delay in care


Sie syndrome of inappropriate enthusiasm
SIESyndrome of Inappropriate Enthusiasm

  • Displays of useless energy akin to entropy

  • Aka ‘Smoke blowing’

  • Includes brown nosing

    Substitutes for hard work

Sie syndrome of inappropriate enthusiasm1
SIESyndrome of Inappropriate Enthusiasm

  • Includes back-stabbing

  • “Some kings stand taller by making their subjects kneel” (an illusion)

    • Don’t promote yourself by stabbing others

    • Obvious even when ‘subtle’

    • Support your colleagues

    • Be seen as a team player

      You don’t want to go here.

Rotation expectations general
Rotation Expectations: General

  • We expect your best  

  • Push yourself  

  • Surgical care = balance & efficiency

    • “Asked to do more than you think you can do in as little time as possible.  

    • Try. You may fail. You’ll get better.”

  • Jump in

    • Good attitude

    • Menial tasks count for the team as much or more than ‘important ones’.

    • No task too menial

      “Cleaning latrines: it's one way to learn that each man's labor is as important as another's.” – M. Gandhi

Rotation expectations
Rotation Expectations

  • Have a card system for your pts


  • Pretend you are patient's only doctor

  • Make patients rely on & trust you

  • Write notes

  • Rounds = Anticipate, Anticipate!!

    • Prepare

    • Dressing supplies ready

    • Help takedown dressings

    • Write orders & get co-signed

Rotation expectations presentations
Rotation Expectations: Presentations

  • Present with purpose & quality, NOT Quantity

  • Plans

    • Always make one

    • Make your own

    • Concise

    • SO…….AP

  • Read every day

Rotation expectations1
Rotation Expectations

  • Track patients throughout day

    • If patient having test... Help make it happen

    • ‘Bird dog’ labs, tests & consult notes

    • Events = notify residents

  • If you have left over time – help others

Rotation expectations2
Rotation Expectations

  • Go to OR whenever possible

  • Tie knots & ask for help

  • On-call

    • Help with notes, consults, post-op checks & evaluating patients 

    • Stick to intern ‘like glue’

  • Don’t disappear – people notice

    • Notify someone

  • Mid-rotation, ask for feedback


  • To get the most……give the most

  • People notice & the rest falls into place

  • Don’t worry about competing

  • Actively participate in all functions of the team

  • Most of all….Be kind


If i d known what it was like to be a patient i d have been a much kinder doctor bruce gilliand md

Bruce C. Gilliland, M.D.Professor of MedicineDivision of RheumatologyProfessor of Laboratory MedicineAdjunct Professor of MicrobiologyAmerican College of Rheumatology Master

1931 - 2007

“If I’d known what it was like to be a patient, I’d have been a much kinder doctor.”

Bruce Gilliand, MD