Here are some essential skills needed if you want to look like a stud during your surgical clinical elective. You may not get a lot of opportunities to practice or demonstrate these skills. But, when the time comes, if you are asked to perform one of these skills and you can do it well it will be noticed. Spoiler alert: instrument tie is not one of them, this is surgery we’re talking about here not emergency medicine!
1. One-handed and two-handed ties.
Learn to one-handed tie using your left hand. This is the proper way to do it because you won’t have to swap the needle-driver between hands when you are actually suturing, saving you an extra step. Also remember when you’re practicing to always push down each knot and tighten with your finger, because this is what you would do in real life. Try to move between throws without dropping and re-grasping the suture.
2. Foley catheter insertion.
I’m obviously a bit biased here being a urology resident, but make sure you can put in a foley without looking like a fumbling idiot. Remember to have all your supplies ready and open before you put your sterile gloves on.
3. Running subcuticular suture.
This is important because one of the few roles a medical student has in the OR is to close skin, so it is your time to shine! I actually spent quite awhile trying to find a good video explaining how to do this technique. I came across a lot of Youtube videos demonstrating it and to be honest most of them are crap. This one is from Duke and is pretty good. It also shows you on real skin which is good because you need to see the skin layers to do this suture properly, and you don’t get that on a plastic model. Also for the initial anchoring suture, the best way to do it is with a single inverted sub cuticular stitch, and then cut one end short and leave the other long for your skin closure.
4. Fast, efficient consults.
Practice your consults and make them quick and efficient. You’re not on an internal medicine elective where the consults are 4 pages long. Think pertinent positives and negatives only. You will learn what these are over time, but try not to include a lot of extraneous information.
5. Procedure notes and post-op orders.
Another thing you can do to help out in the OR and will get noticed is to complete the OR note as well as write post-op orders. OR notes are easy and follow the template:
Pre-op dx, post-op dx, procedure, surgeon(s), estimated blood loss, complications, findings, anaesthetic type, stable to PAR, etc.
Post-op orders vary between senior residents and service, but try to take pictures of someone’s post-op orders so you learn what they like. Pictures on your phone make great references.
Remember that your role in surgery as a medical student is limited, so you only get a handful of opportunities to demonstrate your skills. Make sure you practice so that when you do get those opportunities you can really impress!
Slice of Life 