How to prepare to be an awesome surgery clerk

[Larrivee]

This is probably the best thing you can do - just get into the ER and see how things work. Observerships as well!

 

I don't get what these preclerkship clinical electives are that I hear people talking about. I asked our office of student affairs if such a thing existed at UBC, and they said no. Basically preclerk we can just arrange our own shadowing/observerships. What is it that other schools allow preclerks to do in these electives?

 

Also - I am not sure if I should start a new thread (mods feel free to move if you see fit, no one likes a hijacker) for this or hazard to slightly derail this one. I am wondering the same Q as the OP except for being a an awesome surgery clerk.

[tooty]

I don't get what these preclerkship clinical electives are that I hear people talking about. I asked our office of student affairs if such a thing existed at UBC, and they said no. Basically preclerk we can just arrange our own shadowing/observerships. What is it that other schools allow preclerks to do in these electives?

 

Also - I am not sure if I should start a new thread (mods feel free to move if you see fit, no one likes a hijacker) for this or hazard to slightly derail this one. I am wondering the same Q as the OP except for being a an awesome surgery clerk.

 

Approach surgeons or residents you'd like to learn from and set up unofficial time. It would definitely give you a leg up.

[masterb]

Hijack away, good information to be shared...

I am just wondering for those interested in surgery, is surgical recall in pre-clerkship relevant? also it seems that the hierarchical nature of surgery would warrant becoming proficient at inpatient management first to demonstrate competence amongst higher ups, would it be better to learn to do this in pre-clerkship electives?

[rmorelan]

Hijack away, good information to be shared...

I am just wondering for those interested in surgery, is surgical recall in pre-clerkship relevant? also it seems that the hierarchical nature of surgery would warrant becoming proficient at inpatient management first to demonstrate competence amongst higher ups, would it be better to learn to do this in pre-clerkship electives?

 

Well it never hurts I guess but the recall book without context is a bit weaker - I mean there are things you need to know, should know, and rarely would come up in that book, but it is all listed as being the same. Observerships etc help you put all that in context.

 

The thing I found on my clerkship for surgery is you are going to have both clinical and OR days during your clerkship probably starting right away. It would be ideal if you already knew things like writing post op orders, SOAP notes, how to scrub in, OR rules of sterile fields as well as basic rounding, and clinic work.

[hemogoblin]

I don't get what these preclerkship clinical electives are that I hear people talking about. I asked our office of student affairs if such a thing existed at UBC, and they said no. Basically preclerk we can just arrange our own shadowing/observerships. What is it that other schools allow preclerks to do in these electives?

 

Also - I am not sure if I should start a new thread (mods feel free to move if you see fit, no one likes a hijacker) for this or hazard to slightly derail this one. I am wondering the same Q as the OP except for being a an awesome surgery clerk.

 

At our school you get to do two preclerkship electives per year (or one full year elective per year). There's protected time in our schedule every week (two half days), and you're supposed to use one for elective, and one for self-study. That being said, I often go to my elective more than once per week, or during evenings/weekends because I tend to really like it.

 

What you do depends on your preceptor and your relationship with them. I'm in anesthesia, and after watching the first couple shifts I've basically done every IV/bag mask/intubation since then. In my previous electives (medical subspecialties), I'd go see a patient, do Hx/Px and present them to my preceptor, then we'd discuss the patient and go back in and see them together.

 

We can also book electives for ourselves in the summer if we so choose.

[Larrivee]

Well it never hurts I guess but the recall book without context is a bit weaker - I mean there are things you need to know, should know, and rarely would come up in that book, but it is all listed as being the same. Observerships etc help you put all that in context.

 

The thing I found on my clerkship for surgery is you are going to have both clinical and OR days during your clerkship probably starting right away. It would be ideal if you already knew things like writing post op orders, SOAP notes, how to scrub in, OR rules of sterile fields as well as basic rounding, and clinic work.

 

I am quite familiar with scrubbing in and OR etiquette from the many observerships I've arranged and I've had quite a few opportunities to write in patient charts using the SOAP structure, however, I know nothing about writing orders (of ANY type, let alone post-op) except the ADMIT acronym (Admit to... Activity.... Diet... Investigations.... Therapy...) from clin skills, I also know next to nothing about rounding. Are these things that can be self-taught prior to clerkship or is it just something that you learn when you get there?

Anyone have any pdf books that they'd be willing to share?

[Lactic Folly]

You can read about this in First Aid and other websites such as:

http://students.washington.edu/aomega/surgery.shtml

 

However, there is no substitute for actual practical experience. If you've had the opportunity to write progress notes, can you ask to try writing orders next time? At the beginning stage, you'll just be transcribing what you're told. Failing that, you can look through the chart to see what previous orders have been written. Re: rounding, you can also ask to tag along one morning.

[tooty]

Just dive right in and write your orders. You have to review with staff/resident to get a cosign anyway. You then simply cross off or add items as the staff sees fit. You'll make fewer mistakes as you progress. It's a great way to learn. I've never had a complaint doing this.

 

here are a few more checklists you can draw from. i googled postop orders. they're all pretty similar in my experience.

http://generalsurgery.utoronto.ca/Assets/GenSurgery+Digital+Assets/Education/orientation.pdf

http://northstarsurgery.com/forms/General_Surgery_Admission_Post-Op_Orders.pdf

http://www.palmdrivehospital.org/WEBPhysicianOrderSets/Post-op%20Orders_General%20Surgical.pdf

http://www.who.int/surgery/publications/Postoperativecare.pdf

 

your centre may have a checklist of its own. if not, use these as guides.

[Larrivee]

Sweet, thanks guys!

[soup]

How important is being able to do some simple sutures going into clerkship?

[Lactic Folly]

I learned during my first rural family medicine rotation. Of course, it won't hurt to have some experience going in - the senior medical students / residents put on some workshops for us, and you may be able to pick up some discarded supplies through observerships/electives.

[NutritionRunner]

So SOAP notes are still widely used? We were told in our clinical nutrition class that they were outdated (at least for nutrition purposes).

[Lactic Folly]

The SOAP headings themselves may be not be used, but they do describe how information is generally organized. The exact format and content of progress notes vary widely depending on location and service (and level of training of the writer), so it's wise to get some feedback at the beginning on what the expectations are.

[thebouque]

So SOAP notes are still widely used? We were told in our clinical nutrition class that they were outdated (at least for nutrition purposes).

 

In medicine you almost always write a SOAP note. We don't have the luxury to think about what kind of fancy or trendy note to write (such as SOAPIE etc), we're too busy. Of course you don't write S, O, A, P before the paragraphs.... But you follow the general structure. I even write SOA/P notes, with my analysis and plan combined into 1 paragraph.

[Starling]

How important is being able to do some simple sutures going into clerkship?

 

In my experience, it's been expected that you at least know simple interrupted and subcuticular from the start of clerkship. It's also helpful to know hand ties before OB or surgery rotations.

[A-Stark]

You should know simple interrupted, but subcuticular is something they "teach" in the 1-2 hours of time in the skills lab at the beginning of obs and gen surg. It wasn't especially helpful, and it's not something you can practice effectively on a foam board either.