Surgery

Carle
The pros of having residents is that you learn more of the operations / hierarchy of a more academic style of surgery. The residents you work with may or may not be good teachers, be supportive, or have reasonable expectations on your time. The cons are that there is an extra layer between you and the attendings, meaning you get less personal attention and do less hands on stuff than students in the past. To complicate matters, students are assigned to a team of 3 or 4 attendings rather than one preceptor. Your residents will assign you to different cases and will try to make sure you spend time with each attending on your team. If your resident is more lax about letting you choose who you work with, you should identify early an attending on your team who you 'click' with, and try to spend more time with them.

At Carle you will see the a variety of cases and will have some opportunity to see trauma cases. So far, the pattern has been that students at Carle work 4:30 or 5 - 6 or 7 (13-14 hour days). You will be expected to take overnight call at least once per week and at least one weekend day in your rotation.

This can be a very demanding schedule so it is wise to make sure you are eating and keeping food in your white coat pocket and sleeping when you can.

Vascular, Wheatley
Dr. Wheatley is new at Carle in 2011. He does lots of endovascular procedures, doppler studies, ultrasound, fluoroscopy, as well as open surgeries, making this an excellent rotation for someone interested in interventional radiology. He likes teaching and takes time after each case to ask if you have questions - try to have one ready. At this time, he keeps a light schedule and you'll have a lot of free time to study in the afternoons. If he asks you to do a "formal" case presentation on his clinic day, he really means give the 'assessment' part of the presentation - ie, "This patient has been having rest pain for 2 days, and his foot is blue. He likely has a clot. He needs angiography."

Week 1: Orientation and Lecture
Surgery is the most pimping-intensive field. Most of the lectures are very good, but require preparation ahead of time to avoid having your ignorance exposed. In particular, you MUST read Surgical Recall chapters before the pertinent lectures from Oliphant, as he is said to factor your interactions in lectures into your final evaluation. Some of the residents will also pimp you during their Wed. morning lectures, but this will primarily be anatomy.

Weeks 2-5: General Surgery
You will still have lecture days every Wed. with no clinical responsibilities (some students have been expected to round on Wednesdays before lecture begins). You will be evaluated on 3 things:

How much you know: read Surgical Recall before each procedure. It's also smart to get through one review book (Kaplan or NMS Casebook) in the first week so you have a good foundation (you'll be asked questions on rounds about cases that you aren't prepared for). A few preceptors (esp. Dr. Craddock) will also expect you to have reviewed the chart and seen the patient before the procedure. Most of the OR questions are about anatomy of the area you're working on.

How hard you work: As in any rotation, if you want an O, do more than is expected by reviewing the patient's chart, writing good progress notes, coming in a little early, leaving a little late, volunteering for things like writing a consult H&P, contacting the tranferring hospital, etc. Some students try to do a clinical poster on one of the cases for extra 'points.'

How well your preceptor likes you: Having a good attitude, even when you are tired or are retracting someone's left cheek for debridement of a bed sore, goes a long way. When you are criticized, the only appropriate response is to look the attending in the eye, smile and say, "thank you."

Weeks 6-7: Subspecialty
As above, but largely with a better schedule.

Oral exam
Used as a 'tiebreaker' for your general and subspecialty surgery evaluations - ie, if you got an O from both, this can't hurt you as long as you pass. If you got an O and an A, this will be used to decide whether to round up or down. The exam is not a format that you're used to, but common in surgery because they have an oral exam as part of their board requirements. NMS Surgery Casebook is a great book for preparing for this exam: the format goes something like, "36 year old female comes to you with right upper quadrant pain. Vitals are all normal, except temperature is 101.6. Go." You will then be expected to talk through a focused history, review of systems and physical, generate a differential, suggest some diagnostic tests to rule things in and out, and outline (in a non-technical way) the treatment plan. (ie, you won't have to know HOW to do a procedure, but rather what procedure is indicated, what is is in general terms, what the indications and complications are). If you can, it wouldn't hurt to have a 4th year simulate a short version of this with you - in fact, you should ask your TA to do it with you as a group.

Shelf exam
Students will tell you the surgery shelf is all medicine. This is because most of the decisions a surgeon makes actually happen outside the OR, and involve the medical management of the subset of diseases that are treated by surgeons. Accordingly, you won't get more than a couple anatomy questions and will not be asked about how procedures are done. Rather, you will need to make a diagnosis from a vignette and then suggest the next step in management, which is often something like chest x-ray, IV fluids, NG tube, take a biopsy, etc. The recommended books for the Shelf will prepare you well for these questions. There will also be a handful of questions on things surgeons need to know, though they weren't taught in the surgery rotation (eg, I was asked about the antibiotic regimen for hospital acquired pneumonia). Because of this you'll have a slight edge on the exam if you did internal medicine before surgery, but again, most of the questions are covered in the Kaplan, NMS Casebook and Pestana notes. Books