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

2. Objectives Goals of rotation Role as student & ‘performer’ Insights into the other side Practical tips from UW

3. What are your goals?

4. Goal #1  To learn as much as you can  What you learn is mostly dependent on you  Requires YOUR active pursuit of knowledge Knowledge

5. 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!

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

7. 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

8. 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

9. Surgeons Value patient ownership –Attached to patients in unique way –Bond of trust from surgical event Value ‘appropriate’ initiative Surgery is a team sport!

10. The interns / residents as your ‘audience’.

11. A primary goal of internship is learning to avoid sabotage.

12. 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!

13. 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 SURPRISE!

14. Practical Tips

15. SIE Syndrome of Inappropriate Enthusiasm Displays of useless energy akin to entropy Aka ‘Smoke blowing’ Includes brown nosing Substitutes for hard work

16. 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.

17. 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

18. Rotation Expectations Have a card system for your pts Know EVERYTHING 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

19. Rotation Expectations: Presentations Present with purpose & quality, NOT Quantity Plans Always make one Make your own Concise SO…….AP Read every day

20. 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

21. 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

22. 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

23. “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 Medicine Division of Rheumatology Professor of Laboratory Medicine Adjunct Professor of Microbiology American College of Rheumatology Master 1931 - 2007