General Surgery Rotation & How to Prepare for the PAEA EOR

Rotation #3
Preceptor
: General Surgeon
Location: Dayton, Tennessee (a 3 hour commute every day) 
Responsibilities: Each day before clinic &/or surgery I would report to the hospital and find out if any patients were admitted overnight onto my preceptors care, round on pre-existing patients, and take progress notes on all patients of his on the floor. At about 8am I would either report to the clinic to see pre-op/post-op patients with the physician or I would scrub in for surgery & let the surgeon know of any new findings I noted while on morning rounds. After lunch we would round on the patients together & continue clinic/ surgery until the end of the day. All of my progress notes were handwritten which can be a pain, but it helped me remember the small details/lab values of patients I could recall later when presenting without their chart- so I didn’t mind it after the first few days.

My Personal Rounding Responsibilities: this is different for everyone, but just so you get the idea…(progress note template attached at the bottom)

  • AM pre-rounds + notes

  • PM round with Preceptor and present patient 

  • Pre-Op Post-Op patients:

    • Vitals, Labs, Input/output, Check wounds & note appearance/changes, BM? Flatulence?

    • History & Physical Exam on all*

  • OR: Assist + hands on as much as possible

  • Clinic: H&P’s prior to physician’s encounter with patient

The General Surgery rotation is notorious for being intimidating, making people way more nervous than they should be…especially if you’ve never been in the OR environment, but being nervous is totally okay! Before you get too nervous, let me preface all of this information with these two facts:

1.     Everyone has to start somewhere, give yourself grace.
2.     Don’t take 
anythingpersonal on this rotation.

Now if you don’t read anything else I have ready to knowledge drop onto you, you’ll still be a successful surgical PA student! Below I’ve accumulated a few pearls to overcome your operating room fears to tackle this rotation head on & also provided you with the resources I used to complete my rotation smoothly: 

 First things first, remember to be polite + introduce yourself to everyone: The OR is always filled with various medical students and you want to make sure you make yourself stand out in a positive way.
Know sterile protocol & be PARTICULARLY careful when gowning and gloving: this is the time when all eyes will be in you to make sure you don’t break sterile field (….like even anesthesia will watch, but don’t freak out. Just be ready). If you’re lucky enough the tech will pull gown & gloves for you, so know your glove size when they ask! As the tech gowns you, thank them…gowning yourself is the standard so having someone else gown & glove you is very nice. I personally always double glove even if the OR staff doesn’t (you’re a student, you do not need to risk being stuck by a strangers fluids regardless of the invasiveness of the procedure).

In The OR:
            KNOW YOUR ANATOMY: Each day prior to our days in the operating room I would ask for the schedule & go home and learn as much as I could about each procedure so there was a far less chance something would come as a complete surprise the day of (this helps a ton with nervousness & will give you confidence when answering any ‘pimping’ questions). 
Aside from doing general research on different questions I would have about the procedure, I used Surgical Recall- a book I HIGHLY recommend for this rotation. This book is set up to prep you in a question and answer format & covers the majority of questions surgeons are likely to test you on mid-surgery.
            TAKE INITIATIVEMark my words, this rotation will be exactlywhat you make it. While knowing when to speak and knowing when to stay quiet is important. It’s also important to utilize this rotation to learn(despite the intimidation factor that it’s notorious for)- so, speak up for yourself! Every surgeon loves an assist who can predict his/her next move without breaking the boundaries of their position. This meaning: if there is something you know needs to be done, do it (WITHOUT breaking sterile field). On the same note, if you want more time hands on in the OR- ask for it! No one gets a perfect hand in suturing without practicing on actual humans a time or two, so forget perfection & go for completion. 
            GO ABOVE & BEYOND: If you’re the person who’s scared sh*tless of the OR (which is likely 80% of you reading this…& a totally natural feeling), then the best thing to do to get the help from your OR staff is to HELP THEM. Don’t just offer to help prep the patient, start helping. When the surgeon has closed & broke scrubs, stay. Whether it’s is helping transfer the patient or tidying up the suite- they’ll appreciate it. If your surgeon wants you, they’ll come to get you- but there’s a higher likelihood this will make a more lasting impression. 
CLOSING THE WOUND: At the end of the procedure you may be asked to close, this is the best time to shine! Take your time even if it seems like everyone is watching or wants to rush you along to get the patient out of the room, stay calm & finish your stitch! There’s always time at home to practice on your suture pad & you’ll be surprised how developed your suturing will become as you practice every day on the rotation. 

 Whitecoat Pocket fillers:

  •  Stethoscope

  • Pen, Notepad, Penlight

  • Template for rounding until memorized

  •  PROTEIN BARS!

  • My surgical recall book: for downtime between surgical cases

  • Supplies for incision/wound checks: Dry gauze, Xeroform occlusive gauze, Alcohol prep pads, suture removal kit, staple extractors (sterile), scissors, iodiform gauze, tape, saline flushes
    (you certainly do not need alllll of this, but it wouldn’t hurt if you’re rounding post op)

The Exam & Resources Used to Prepare
KNOW ALL THINGS GI: Check the topics I’ve listed below based on the blueprint by PAEA

Podcasts: Behind the Knife (created for residents, but high yield episodes esp. in GI), Physician Assistant Exam Review, MedGeeks 
I used Rosh Review’s Surgery Mock exam which I def recommend!
Progress Note Template

Remember:  Don’t take anything personally on your Surgery rotation! The OR is a completely different animal & the personalities inside it are unique. If you aren’t at this point yet, just relax…PA school will prepare you best for your surgery rotation & you WILL know more than you think! Take each day of this rotation day by day, keep your chin up! 

I hope this helps! As always please feel free to reach out via email or below! If you have any additional advice you would give to a student that I may have missed please add to this post in the comments below!

XO,
AK

 

Ashley MunnsComment