A little late to posting this because I had my General Surgery rotation back in October BUT here are my tips for Gen Surg. In October, all elective surgeries were still cancelled due to COVID-19, so I saw probably 15 appys and lap choleys a day. I also worked with an amazing breast surgeon and so I assisted with lumpectomies, which was my absolute favorite.
Overall, it's an honor to really just watch, and anything your preceptor lets you do beyond that, take the opportunity.
My typical schedule:
06:00AM: Arrive to the hospital, scrub in and change into hospital provided scrubs, print out schedule and check on patient updates (usually use Avagard throughout the rest of the day)
07:00AM: Start pre-rounding, then round with the surgeon
Variable times:
- Surgeries
- Checking in at clinic
- Lunch (Perks: free food at the hospital)
19:00PM Usually done by around
Operations/Procedures I saw/assisted with:
- Laparscopic cholecystecomies
- Open and Laparscopic appendectomies
- Colonic resections
- Port Placements
- Lymph Node biopsies
- I&D Seromas
- Biopsies
- Hemmorhoid banding
- Hernia repairs
- Lumpectomies
- Skin grafting
My usual duties:
- Hold retractors
- Make incisions
- Insert pegs
- Suture
- Hold the camera for lap procedures
- Inject local anesthetics
- Intubate
- Help insert and remove chest tubes and NG tubes
Favorite Resources:
- Online MedEd
- Uworld
Phone Apps to download:
- MDCalc (specifically for Child-Pugh and Ransom Criteria)
- UpToDate
- Epocrates
- DynaMed
- DxSaurus
Common Cases to read up on:
- Appendicitis
- Bowel obstruction
- Breast cancer
- Carotid stenosis
- Cholecystitis
- Colon cancer
- Diverticulitis
- Inguinal hernia
- Thyroid nodules
- Resection
Gen Surg Tips:
- Always wear gloves so you're always prepared and ready to assist at a moments notice
- Practice suturing and hand ties
- Eat whenever possible
- Drink IV Hydration to stay hydrated/avoid passing out
- Be friends with the nurses and scrub techs. they know how to suture
- Read up on cases the night before
- Always say thank you
- Stay behind and help clean up in the or
- Know the patients and meet them before going into the OR (not only do you remember the case more, but also it becomes more personal and real, and you'd probably want that if you were the patient)
Check my tips for first day in the OR blog post for more details on what to expect, how to scrub in, and more general tips!
Pro tip: carry needle drivers with you to practice palming the instrument
A needle holder/driver is a surgical instrument, similar to a hemostat, used by doctors and surgeons to hold a suturing needle for closing wounds during suturing.
Fun fact: you're actually not supposed to put your fingers into the needle driver holes, like you would a pair of scissors. The right way is by palming the instrument, so that you open and close the driver with your thenar eminence. You have much more control over the direction that you angle your hand to drive the needle this way.
This was really challenging for me, not sure if I'm just really weak or if it's hard for other people too hahah. But it took a lot of practice to finally open and close correctly and with ease. What helped the most was to practice during any downtime and using it kind of like a fidget spinner.
If you're a beginner, you can put your ring finger and thumb in the holes and guide the needle driver with your pointer -- at the end of the day, suturing effectively is the most important regardless of whether or not it’s the proper technique.
Here are some good video tutorials for all you visual learners. Watching then practicing is probably the best way to learn the technique:
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