How to Make the Most of Your Surgery Clerkship/Rotation

“Cutting out bad habits is far more effective than cutting out organs.” 
― Herbert M. Shelton, Fasting for Renewal of Life

Now that my Surgery Rotation is over, I thought it would be best to share with you all some things I learnt during the rotation as well as things I would have done differently if I knew at the inception of the rotation which may have allowed me to cover more material during the 8 week period.

How to Make the Most of Your Surgery Rotation

1. Gather Your Resources

For some of you eBooks are more convenient; for others hard copy books are a must. Whatever works best for you, before starting your rotation review the recommended book list provided by your school for your Surgery rotation and if possible, either purchase a physical copy or download an eBook or PDF if one is available. By doing this it will ensure you never delay your reading because of a lack of resources.

Also, if you're one who is keen on organization and having things set up in a particular way for each rotation or when you go to study, it may be in your best interest and that of your pocket to purchase all of the necessary items you would need in bulk so you won't be stuck without a post-it note, or finding yourself running out of pens or pencils when you sit down to study. 

2. Schedule Your Activities

Some teams during the rotation will require your presence during your call nights. Yes; 24 hour calls in medical school-THEY DO EXIST. 

As you may very well be on such a team, get in the habit of either using Excel or Word or whichever software that suits your fancy to construct a detailed timeline of each day. By doing this you will ensure you never miss an assignment, you're keeping up with the necessary reading and you're aware of where you're expected to be at a given point.

3. Read Around Your Patients DAILY

As I move from one rotation to the next, I'm always reminded to read around the patients I interact with as this is the easiest way to ensure I'm actively learning and constantly reading. It also makes it easier to understand certain illnesses and how they are managed- believe it or not. 

Take your Consultant's word for it, whenever you see a patient, take interest in knowing everything there is to know about their condition and be sure to voluntarily (either during rounds or in between surgery cases) inform them of what you read or understand and ask those questions that may have came up during your reading that you just couldn't figure out. REMINDER: Don't use this time to ask a question that you can easily find the answer to if you think about it or simply read. Rather ask questions about why a particular drug was used if in your reading you saw that another class of drug is commonly preferred. 

4.  Create a Study Group

If your Medical School has end of Clerkship Oral Examinations, it would be in your best interest to practice not just by yourself, but with a group of people that you're not only comfortable with but who you can seriously study with. 

As clerkships are rather short, you don't have time to waste so forming study groups with friends who you won't really study with will be a disadvantage to you and that's not what we want. Make the most of each study session, by using your case reports as practice and to gather possible questions that may be asked in the examination. 

This is your opportunity to truly learn various topics well. It is recommended that study groups should not exceed 4 persons, but I will leave that to your discretion. 

 The sooner your group is formed, the better. You can arrange to practice and study once or twice a week until a few days before the examination. By doing this you will be well prepared for your Orals and your fear of being questioned by a consultant that you may not have interacted with, will be diminished if not completely eradicated. 

Recommended Surgery Textbooks

These are a few books that I started using towards the end of my rotation, mainly because that's when I came to gather them all. The order in which you use them, is solely up to you and your study style. 

1. Scott: An Aid to Clinical Surgery- Robin Charles Noel Williamson 

2. Browses  Introduction to the Symptoms and Signs of Surgical Disease- Norman L. Browse

3. Davidson's Principles and Practices of General Surgery- James Garden

4. Bailey and Love's Short Practice of Surgery- A.J. Harding Raines

5. Robbin's Basic Pathology

6. First Aid for the Surgery Clerkship- You should be able to read this book through at least twice during the course of your clerkship depending upon the length of your rotation. 

Those are the books that I consulted whenever I needed to know anything about a particular condition. If I could do it all over again, before my Surgery rotation (maybe the weekend before) I would have went on the wards and read the doctor's orders book to get an idea of the common surgical procedures that are performed regularly at the hospital and then inquired with any of the Senior House Officers or Interns about the odd surgeries that are performed. 

Based on this information I would have started reading up on them in Scott's, used Browse's for the presentation of each condition and then read up on them a bit more in Bailey and Love's to familiarize myself with the management and imaging techniques and review the pathology in Robbin's. Davidson's would have been saved for my post-rounds reading and note taking. 

As always, I hope you find this information helpful in one form or another and I wish you all the best with your Surgery rotation. 

Remember preparation and diligence is key!

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I Survived My First Week of My Surgery Rotation

With my second week of my Surgery rotation on the brink, I can say that the first week of surgery was not at all what I had expected it to be. Yes the stereotype holds true as far as Surgeons equated themselves with a god, however, not all of them are that way.

From the inception, regardless of the fact that our team is predominantly male (we're the only females on our Team), I have yet to experience a lack of respect. Each member does he part to ensure we are learning, actively engaged and participating in the management of the patients on the service as well as corrected when we are wrong or going down the proverbial rabbit hole.

All in all, I'm excited to learn in light of the amount of reading that I have to do on a daily basis and I am eager to take part in the intellectual discussion that occurs at the bedside during rounds. This week will be the start of our presentations on rounds-I can already sense it won't be what I've grown accustomed to during my Medicine rotation.

Here's to a new week.

Studying and Clinical Rotations: How to Find A Balance

Unless you try to do something beyond what you have already mastered, you will never grow.

Ronald Osborn, teacher and writer Once again we're talking about balance. This time it's regarding how to find balance during 4th year clinical rotations.  Within the past week, I have switched teams for my Internal Medicine rotation. It has it's advantages and disadvantages and although it's already been five weeks, I cannot honestly admit that I have found a routine just as yet. I will say however, that since I've been on this new team, I have found time to find balance which I lacked initially that I can now apply to the remainder of this rotation and carry on to my next rotation which is Surgery.  When we discuss balance, we evaluate ourselves holistically. We take into consideration our daily personal well being that encompasses our physical, emotional and spiritual make up. With medicine and as students this still applies because as we are doing our best to learn and study ways to properly manage and treat patients, we must also know how to firstly, take care of ourselves and our health.  Let's get into it. Here are 6 tips on how to balance studying and clinical rotations based on my first 2 months of Internal Medicine rotation which can be adapted as you switch rotations.  6 Tips for Balancing Clinical Rotations and Studying  1. Read  As we know, as medical students we tend to learn best not simply hunched over a textbook in a quiet spot with Starbucks and a variety of highlighters, but by actually taking care of patients. This last week I had the pleasure of taking care of doctor, who told me that the best way to learn is by examining patients EVERY day and by taking a good history. By spending the time at the bedside, you are actively learning and this is one of the BEST ways to make knowledge stick. Once you've sat and taken a detailed history and constructed a problem list based upon the presenting complaint and the laboratory values and other investigations results, do your best to READ up on your patient and then go the extra mile and read up on ALL of the patients that are on your team or those admitted to the rotation that you're in at the time. Yes it does sound tedious, but as time is limited and you don't have the luxury of spending 8+ hours a day to study as you would have during the first three years, every minute counts. What I've found that works for me is that after gaining as much information as I can from my patient, I try to access Up-to-Date either by mobile or on the wards and read as much as I can about the patients I am seeing first and then those on the service I am on. After doing this, I make notes or questions and then discuss the assessment and plan with my Senior House Officer or Intern and do my best at actively participating or contributing to the discussion on rounds. Also, reading an hour consistently throughout the month helps reduce the need to cram and allows you to construct a plan of care for the patients on your team.  2. Practice Questions Practice questions may be hard to source during the first few weeks, however they are easy to come by if you do your best to network with those in higher years OR simply by searching the internet for exam questions based on the specific rotation you are in. By getting in the habit of answering practice questions EVERY night, you're exposing yourself to a range of questions, some of which you can even ask on rounds which will benefit everyone on your team.  NOTE: By reading intensely during the first half of the rotation and doing lots of practice questions as well as compiling notes, by the week before exams you're able to simply review your notes and the answers to the questions as well as focus on the more important or weaker areas the week of the exam.  3. Early to bed; Early to rise Trust me, you will want to do nothing more but to sleep at the end of each day. You will be mentally and physically exhausted, however try not to crash every day. By getting to bed early after reading and waking up early you would be able to get some reading done in the mornings. Use your time wisely and as far as possible abandon the thinking that what reading you did not do or complete the night before will be done the next day. It seldom happens and what you'd want to do this year is to tackle the work as it comes rather than letting it all pile up.  4. Take advantage of the down time While on call do your best to get things done. Be it working on your clinical examination skills for OSCEs or completing other tasks that may be required for your school. Accident and Emergency is the ideal place to work on venipuncture, peripheral line insertions, inserting nasogastric tubes an catheters and watching procedures. I was able to get some of these things signed off on, in less than an hour and gained the confidence as well. During call hours, make use of the time you have to read as well and to study, these times are ideal for learning normal reference ranges and interpreting laboratory data.  5. Ask questions Questions are ways by which we learn. Gaining the confidence to ask them on rounds may take time especially if you spent the last three years as a small fish in a big pond (in a class with 200+ students). Moving from a large class size to a team consisting of less than six people can be intimidating at first but it gets easier with time and the more you read. Whatever you do, DO NOT leave questions that you have (and these are those questions you have after reading articles or textbooks) for later. You will forget, another patient will be added to the team and you'll never know the answer. Take advantage of the teams you may be on that consist of interns or SHOs that LOVE to teach, also, don't simply take their word for it either; be sure to find the answer as well as guidelines and practices often change of which they may not have had the time to look up.  6. Don't lose yourself  Be sure to stay true to who you are. Try not to give up the simple pleasures of exercising, health eating and spending time with family. Schedule a day off and do something other than medicine but be sure you're also scheduling time to study, read and practice exams as well.

Unless you try to do something beyond what you have already mastered, you will never grow.

Ronald Osborn,
teacher and writer

Once again we're talking about balance. This time it's regarding how to find balance during 4th year clinical rotations. 

Within the past week, I have switched teams for my Internal Medicine rotation. It has it's advantages and disadvantages and although it's already been five weeks, I cannot honestly admit that I have found a routine just as yet. I will say however, that since I've been on this new team, I have found time to find balance which I lacked initially that I can now apply to the remainder of this rotation and carry on to my next rotation which is Surgery. 

When we discuss balance, we evaluate ourselves holistically. We take into consideration our daily personal well being that encompasses our physical, emotional and spiritual make up. With medicine and as students this still applies because as we are doing our best to learn and study ways to properly manage and treat patients, we must also know how to firstly, take care of ourselves and our health. 


Let's get into it. Here are 6 tips on how to balance studying and clinical rotations based on my first 2 months of Internal Medicine rotation which can be adapted as you switch rotations. 

6 Tips for Balancing Clinical Rotations and Studying 

1. Read 

As we know, as medical students we tend to learn best not simply hunched over a textbook in a quiet spot with Starbucks and a variety of highlighters, but by actually taking care of patients.

This last week I had the pleasure of taking care of doctor, who told me that the best way to learn is by examining patients EVERY day and by taking a good history. By spending the time at the bedside, you are actively learning and this is one of the BEST ways to make knowledge stick.

Once you've sat and taken a detailed history and constructed a problem list based upon the presenting complaint and the laboratory values and other investigations results, do your best to READ up on your patient and then go the extra mile and read up on ALL of the patients that are on your team or those admitted to the rotation that you're in at the time.

Yes it does sound tedious, but as time is limited and you don't have the luxury of spending 8+ hours a day to study as you would have during the first three years, every minute counts. What I've found that works for me is that after gaining as much information as I can from my patient, I try to access Up-to-Date either by mobile or on the wards and read as much as I can about the patients I am seeing first and then those on the service I am on. After doing this, I make notes or questions and then discuss the assessment and plan with my Senior House Officer or Intern and do my best at actively participating or contributing to the discussion on rounds.

Also, reading an hour consistently throughout the month helps reduce the need to cram and allows you to construct a plan of care for the patients on your team. 

2. Practice Questions

Practice questions may be hard to source during the first few weeks, however they are easy to come by if you do your best to network with those in higher years OR simply by searching the internet for exam questions based on the specific rotation you are in.

By getting in the habit of answering practice questions EVERY night, you're exposing yourself to a range of questions, some of which you can even ask on rounds which will benefit everyone on your team. 

NOTE: By reading intensely during the first half of the rotation and doing lots of practice questions as well as compiling notes, by the week before exams you're able to simply review your notes and the answers to the questions as well as focus on the more important or weaker areas the week of the exam. 

3. Early to bed; Early to rise

Trust me, you will want to do nothing more but to sleep at the end of each day. You will be mentally and physically exhausted, however try not to crash every day. By getting to bed early after reading and waking up early you would be able to get some reading done in the mornings.

Use your time wisely and as far as possible abandon the thinking that what reading you did not do or complete the night before will be done the next day. It seldom happens and what you'd want to do this year is to tackle the work as it comes rather than letting it all pile up. 

4. Take advantage of the down time

While on call do your best to get things done. Be it working on your clinical examination skills for OSCEs or completing other tasks that may be required for your school.

Accident and Emergency is the ideal place to work on venipuncture, peripheral line insertions, inserting nasogastric tubes an catheters and watching procedures. I was able to get some of these things signed off on, in less than an hour and gained the confidence as well.

During call hours, make use of the time you have to read as well and to study, these times are ideal for learning normal reference ranges and interpreting laboratory data. 

5. Ask questions

Questions are ways by which we learn. Gaining the confidence to ask them on rounds may take time especially if you spent the last three years as a small fish in a big pond (in a class with 200+ students). Moving from a large class size to a team consisting of less than six people can be intimidating at first but it gets easier with time and the more you read.

Whatever you do, DO NOT leave questions that you have (and these are those questions you have after reading articles or textbooks) for later. You will forget, another patient will be added to the team and you'll never know the answer. Take advantage of the teams you may be on that consist of interns or SHOs that LOVE to teach, also, don't simply take their word for it either; be sure to find the answer as well as guidelines and practices often change of which they may not have had the time to look up. 

6. Don't lose yourself 

Be sure to stay true to who you are. Try not to give up the simple pleasures of exercising, health eating and spending time with family.

Schedule a day off and do something other than medicine but be sure you're also scheduling time to study, read and practice exams as well.