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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!

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