Office of Academic Support & Counseling

Surgical Rotation

Ted Melnick, MD, Medscape Contributor, "How Should I Prepare For A Surgical Rotation?" 

Attending Physician, Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York 

“I will soon be entering my fourth year of medical school, and I just learned that I've been assigned to a surgical rotation of which the surgeons are known to have very high standards and the failure rate for students is very high. However, I've decided not to swap rotations. How should I prepare myself for it?” 

The surgical culture is very demanding and can intimidate the unprepared student. I remember struggling through my third-year surgical clerkship and being quite apprehensive of my required fourth-year surgical sub-internship. However, I was surprised to discover that my third-year clerkship had prepared me well for the sub-internship.

As a fourth-year student, the skills that you have gained over the previous year can make you a valued member of the patient care team. The expectations of a final-year medical student are much different from those of the inexperienced, timid third-year student. You have a different knowledge base; you hopefully have some procedural skills; and you understand the workings of the hospital. The mere fact that you are already thinking ahead and have decided to accept the challenge of a more "difficult" rotation will put you in a better position for success.

The overwhelming amount of work expected of the surgical resident can be lightened by a helpful, hardworking fourth-year medical student. If you are able to reduce a resident's workload, he or she will likely think positively of you and will provide positive feedback to the clerkship director.

Here are a few guidelines to follow in order to survive, pass, and maybe even flourish on your fourth-year surgical rotation.  

  1. Arrive on time: Surgical rounds occur as a team. If you are late, the whole team will be waiting for you and will be unable to round on time. In fact, if you arrive a few minutes early every day, you will stand out as someone who understands teamwork and is there to help.
  2. Don't draw negative attention to yourself. Especially in the operating room (OR), don't speak unless spoken to. Although this sounds authoritarian, remember that surgery requires incredible dexterity and concentration. Asking a question at an inopportune time in the OR may distract the surgeon at a critical point in the procedure that he or she is performing. This also holds true on rounds. Time is limited there, so the team is trying to accomplish as much as possible as efficiently as they can. If you draw attention to yourself on rounds for anything but contributing to getting the job done, you may leave a bad impression.
  3. Help with floor work: An overworked surgical intern will sing your praises to his or her seniors if you help with some of the floor work, allowing him or her to get home a little earlier or to spend more valued time in the OR. You may want to read and carry The Surgical Intern Pocket Survival Guide. This small reference offers all sorts of pearls that will come in handy while taking care of routine floor work and charting.
  4. Familiarize yourself with the book, Surgical Recall: This book is indispensable. It provides just about any question that a surgeon has ever used to "pimp" a medical student. Find out which procedures you will be scrubbing for the next day, and read that section beforehand. You should also review anatomy relevant to the procedure in your first-year anatomy textbook. You can even go the extra mile by familiarizing yourself with the procedure in a surgical textbook. To the attending and senior residents, you will appear prepared, interested, and dedicated to the patient.
  5. Sleep and eat whenever you can: This statement is true throughout your clinical years in medical school. However, it is even more important on time-intensive rotations, such as surgery. A little nutrition and rest can make you much happier and more productive.