Transcript How to Ace Your Surgery Rotation Karen Horvath, MD, FACS Professor of Surgery Residency Program Director University of Washington.

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
 To learn as much as
you can
 What you learn is
mostly dependent on
you
 Requires YOUR
active pursuit of
knowledge
Knowledge
Knowledge in Surgery
• Experiential = active
participation
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Hands-on, concrete
Changing dressings
Writing notes
Collecting labs
OR & clinic
• Surgical concepts
acquisition
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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 #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’?
• Surgeons are…..
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Detail-oriented
Direct
Concise
Practical
Logical
Linear
Efficient
Organized
Committed
Multi-taskers
Type A (perfectionists)
Strong work ethic
Awesome
Surgeons
• 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’.
A primary goal of
internship is
learning to avoid
sabotage.
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!
• Potential saboteurs
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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
SURPRISE!
Practical Tips
SIE
Syndrome of Inappropriate Enthusiasm
• Displays of useless
energy akin to entropy
• Aka ‘Smoke blowing’
• Includes brown nosing
Substitutes for hard work
SIE
Syndrome 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
 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
• Have a card system for your pts
• Know EVERYTHING
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Pretend you are patient's only doctor
Make patients rely on & trust you
Write notes
Rounds = Anticipate, Anticipate!!
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Prepare
Dressing supplies ready
Help takedown dressings
Write orders & get co-signed
Rotation Expectations:
Presentations
• Present with purpose & quality,
NOT Quantity
• Plans
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Always make one
Make your own
Concise
SO…….AP
• Read every day
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 Expectations
• Go to OR whenever possible
• Tie knots & ask for help
• On-call
– Help with notes, consults, postop checks & evaluating patients
– Stick to intern ‘like glue’
• Don’t disappear – people
notice
• Notify someone
• Mid-rotation, ask for feedback
Summary
• 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
Patient
Bruce C. Gilliland, M.D.
Professor of Medicine
Division of Rheumatology
Professor of Laboratory Medicine
Adjunct Professor of Microbiology
American 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