Transcript Surgery Clerkship AOA NIGHT 2013 TIPS AND TRICKS LIZA SONNENBERG ([email protected]) PHILLIP DOWZICKY ([email protected])

Surgery Clerkship
AOA NIGHT 2013
TIPS AND TRICKS
LIZA SONNENBERG ([email protected])
PHILLIP DOWZICKY ([email protected])
Schedule and Locations
4 weeks of General Surgery
HUP (GI Blue, GI Red, EOS, Trauma, CRS)
Presby
Pennsy
2 Surgical Specialties, 2 weeks each
Plastics, Vascular, Thoracic, Neuro, SICU,
Transplant, etc
General Surgery Block
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Round with chief resident and intern(s)
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Start time changes daily, check with interns the day before,
usually starts between 5:30-6:30 am.
Bring the scut bucket (more on the next slide)
You will be in the OR most days. Cases usually start
at 7:15 am.
1-2 days/week may have clinic
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See pre-op and post-op patients
May shadow attending, but try to see pts on your own and
present A&P to attending
Always plan on wearing dress clothes to clinic
Pre-rounding
It will be early. Painfully early. Generally, you are
responsible for pre-rounding on any patient you
observed in the OR.
Learn to become efficient. See pts first, then write up
SOAP notes.
Restock the scut bucket: Extra ABDs, gauze, tape for
dressing changes. Empty syringes for foley catheter
removal. Scissors, suture removal kits, skin staple
removal kits.
SOAP Note: Daily Progress Note
Events from yesterday and overnight
Subjective: how pt is feeling - GI function?
Objective: Vitals, I/Os (extremely important, include urine
output, drain output, comment on drainage: serosanguinous vs
purulent, etc)
PE: Appearance
Pulm
Cardiac
Abd: Dressing is clean, dry and intact (C/D/I), or comment
on wound: nonpurulent, mildly erythematous, etc.
Extremities
Neuro
SOAP Note continued
Assessment: Mr. S. is a 25 yo with appendicitis now
POD#1 s/p laparoscopic appendectomy….
(POD#0 is the day of the surgery)
Plan
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Pain management
Wound care
Diet
Foley catheter/line removal
Manage chronic medical conditions: DM, HTN, etc
○ Restart home meds?
● Encourage incentive spirometry and getting out of bed (IS and OOB)
● DVT ppx or anticoagulation (for onc pts)
● Outpatient follow-up
Note about I/Os
In Sunrise, select your patient
Select Flowsheets Tab
Bottom left hand corner: select I/Os
Scroll down to see urine output, drain output, chest tube
drainage for the past 24 hours
Ask your resident to walk you through it first
Pre-OR
Look up the schedule and know what cases you have
(how-to later)
Read the patient’s pre-operative evaluation in
Medview (more later)
Have some familiarity with procedure
Introduce yourself to the patient in the PRA (perioperative receiving area)
In the OR!
ANTICIPATE!
Try to figure out what the resident or attending will
need before they ask for it!
● Suction like it’s your job. Because it is!
● Retract, retract, retract! Visualization is everything.
● As soon as they ask for suture, you ask for the
suture scissors. Be ready.
● It’s ok to ask some questions -- but judge for the
right calm moments….
Sub-specialties
These are PASS/FAIL
Show up on time
Be interested
Be helpful
Don’t stress
Topic Presentations
● Start with a summary source (UpToDate)
● Be focused! Brevity is the soul of wit here more than
ever.
● Start with a clinical scenario (usually what prompted
your talk)
● Make a handout. But say more than is on the handout
● Incorporate actual evidence: UpToDate is a great
place to find references, then you can quote the actual
papers
● End strong: Zinger, 3 take away points
General Tips for Success
● Always ask what you can do to help
● Always stay with your patient: bring them to the
PACU after surgery and stay there until the PACU
team has assumed care
● Find ways to be helpful and independent
● Be friends with the nurses and the scrub nurse!
● Be interested, self-motivated, ask questions
● Be punctual! And be prepared to work long hours.
● Don’t ask to leave. Ask if if there is anything else you
can do to help.
● Practice knot tying and suturing at home.
Tips for the Shelf
The shelf covers surgery, but also medicine and
ob/gyn material
Mainly the work-up, diagnosis and management of
surgical diseases (often medical management
BEFORE surgery)
Specifics of procedures and anatomy will likely NOT
be on it
Books for the Shelf
Pestana!
Read it cover to cover 2-3 times
First Aid for the Surgery Clerkship
NMS Casebook
Surgery Case Files
High-yield chapters of medicine book (Step-Up)
Question Resources
Kaplan QBook**
UWorld questions**
Lange Q Book
Pretest
Other Helpful [non-shelf] Resources
Surgical Recall:
you will get pimped on material directly from
this book! Carry it with you if you can.
From Access Medicine:
Kharti Operative Manual
Great review of pertinent anatomy and main steps of the
procedures
Sabiston Textbook of Surgery
Supplemental stuff
Supplemental stuff
● UpToDate from Home
● Access the hospital's Extranet at
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https://extranet.uphs.upenn.edu/
Use your MedView username / password to log in
Create a bookmark on your home page for UpToDate
Click on the "+" that's on the far right side of the "Web
Bookmarks" heading
Name your bookmark and put this URL in the URL spot:
http://uphsxnet.uphs.upenn.edu/uptodate
Click on new bookmark that's now on your home page
Use UpToDate like you would from on campus
Don’t let your empathy get
fatigued!!
TAKING AN EXTRA MOMENT TO LISTEN TO
YOUR PATIENT IS A GOOD WAY TO IMPROVE
PATIENT CARE, HELP YOUR TEAM, AND MAKE
THE EXPERIENCE MORE FULFILLING FOR
YOU.
From your upperclassmen-and-women
It all became worth it when…
“... When I would stay in the room with my patients in the busy outpatient clinic
after the surgeon had left the room, and would go back over everything that had
just happened with them multiple times until they felt comfortable and had all
their questions answered.”
“...When a scrub nurse, who I initially found to be very intimidating, came out to
find me at the end of my first week to say bye and give me sutures for practicing
at home.”
Support Systems
Clerkships can be stressful and emotional, but you are never alone.
Suite 100:
- JoMo, Barb, Helene
- Tutors set up through suite 100
Organized counseling:
- CAPS: http://www.vpul.upenn.edu/caps/
- Therapists in the community (Barb from Student Affairs can provide names and contact info)
- Paired mentoring: SNMA, LMSA, Elizabeth Blackwell, House mentors
Other people to turn to:
- Doctoring preceptors
- Advisory deans
- Clerkship directors (it’s really ok to talk to them!)
- Mentors you have connected with in pre-clinical years (through clinics, volunteering, etc)
- Friends and family outside of medicine