*This post was updated July 2019.* It’s 4 AM and your alarm is going off. You have to have “breakfast,” (i.e. a glurgle of milk or handful of dry granola from the passenger seat of your car), make sure your belongings are together, and get to the hospital for pre-rounding. If you are a real hot shot, you might even squeeze in a morning shower, but then again, maybe you will talk yourself out of it with the thought of the excrement, blood, and bile you might find yourself covered in today. You’ve been waiting all year to break in your Danskos only to realize that they look cooler and feel better on everyone else’s feet. And the coffee you swore you wouldn’t get addicted to has become a necessity to get you to the next hour.

Surgery is demanding. It can be intimidating, as can the personnel that you will encounter daily. But never fear! We put together this guide to get you through. Follow these SIMPLE steps to get the most out of your rotation, look like a rock star, and do more than just survive.

The night before, read about and watch the case you will be scrubbed into.

The more you know about a procedure, the more you can be actively engaged in learning. And without a little preoperative exposure to the task at hand, obvious entrails and key landmarks will be alien to you. You are a Google search away from the answers you need. YouTube can also be a great resource, as plenty of surgeons will videotape the key parts of surgeries for educational purposes. The best resource I’ve found is probably UpToDate, for which your school might provide a free subscription. To prepare yourself for being aggressively pimped in the OR, you can browse through old standbys like Pocket Surgery or Surgical Recall. NMS Casebook is another surgery favorite. Reading up will clue you in on the possible complications and structures to look out for. You will get so much more value, and the experience will be incredibly more enjoyable with a little self-education the night before.

Follow a single patient.

Although logistics can sometimes make it difficult, in a perfect world, you should follow a particular patient pre-operatively, peri-operatively, and post-operatively. This longitudinal exposure will give you the most telling experience about surgery in general. Not everything is a big sexy operating room story; there’s a lot of vomiting, ileuses, and wound infections to learn from too. While you are following a patient, you should know up to date information about his or her hospital course. What is his creatinine this morning? Is her hemoglobin stable? Any overnight events? Have the cultures results come back? By knowing this information, not only will you be a valuable asset to your team and optimize patient care, but you will you look great and get the feel for managing patients.

What’s more, this clerkship is about you showing that you can reason clinically. Your technical mastery will come with time, so your focus should not be on going in there to show that you’re the best knot-tying 3rd year who ever walked the  face of this planet. Read up on your patients and know your pathophysiology.

Along those lines, whether or not you are asked to, you should write a note.

Mind you, I’m not advocating doing busy work just for the sake of doing work. Writing a note, especially when you’ve got the time to focus on a singular note instead of throwing signatures mindlessly on a batch of 25 notes (translation = intern year), is a valuable educational exercise. It will get you in the habit of systematic thinking and ensuring that all of a patient’s issues are covered. Again, you will be an asset to the patient and your team by making sure nothing slips through the cracks. 

Study when appropriate.

There is a pretty wide compendium of information that you must know for the surgery shelf exam, and like any good student, you should fill your free time with studying for the exam. However, you cannot forgo your clinical duties because you “have to study.” Getting exposure to cases in the operating room, staying up to date on the status of your patients, and helping team members in any way they need help takes precedence. You will internalize the management of a small bowel obstruction with much more confidence if you helped get that nasogastric tube into Ms. Stevens’ stomach instead of reading bullet points in a review book. Learn by doing! (And if you haven’t already ready done so, get to know thy surgery shelf here.)

Be genuine in your offers to help, especially when you want to call it a day.

Your residents were not born yesterday, and they have lives too. They understand the joys of being at home as much as you do, and hopefully will try to get you out when the enriching part of the day is over. You will undoubtedly find a clandestine way to ask to go home… everyone does it, and it is certainly the lesser evil than asking the chief resident, “Can I jet now?” That said, please, for everyone’s sake, make sure your desire to help the team is at least as great as your desire to go home. Don’t give a half-hearted “Do you need more help?” without meaning it. Being a team player is wildly important, and if you are uninterested in doing so, it will definitely be noticed.

Work hard.

There are no two ways about it: Your surgical rotation will be difficult and require a lot of hard work, for which there is no substitute. Just do the work. Period. 

Let’s start some chatter! Medical students: What helped you succeed on your recent surgery clerkship? Residents: What are you looking for from your medical students?