Surgery Rotation / Clerkship: How to Survive It

I don’t know what is more depressing: working 13 hours a day during the beautiful summer months of July and August -or- never seeing the light of day for 6 weeks. Whatever you choose, you cannot win. Welcome to the crappiest rotation (both literally and in terms of life style): surgery rotation.

My Experience with Surgery Rotation

In the above lose / lose scenario, I actually chose the first option. This was my very first rotation. I heard how hard it was going to be, so I just wanted to get it over with.

Surgery rotation started out quite nicely. For the first two weeks, I was placed in a small, community hospital. There were only a few patients, and only a few cases to scrub into. The resident was also super nice and friendly. Not only did he teach me a lot, he also bought me lunch! (I guess his lunch credits for the month was going to expire soon.) And the attending was the kindest guy I have ever met, even to this day! So I thought to myself, “If this is surgery, then this isn’t so bad. What were people talking about when they said surgery is the toughest rotation?”

Every day, I went to rotation with unwavering enthusiasm. I was actually looking forward to it. If I could have spent my whole 6 weeks there, I would have been a happy medical student.

Alas …

As Nelly Furtado sang, all good things come to an end. (Doesn’t that song remind you of a summer fling?) After 2 weeks, I was transferred to another hospital. It was a larger hospital, with a larger patient list. The surgical cases were longer and the residents were meaner.

Still, it wasn’t so bad … at first. The first group of residents were ok. They didn’t care so much about medical students, but overall they weren’t bad. They were like the cool, laid back kids who often joked around. I then spent 1 week in anesthesia. I felt like an orphan because no anesthesiologist took me (and the other student) under his or her wing. So like orphans, we pretty much ran free. It was pretty chill.

But after returning from anesthesia, a different group of residents was waiting for me. A more sinister group. This group has the classical characteristics that all medical students hate: bitter, mean, bullying. To be fair, only two people in the group was malignant. But one of them was the chief resident. My last two weeks with this group felt like the longest two weeks of my life. I could not stand the group so much that I asked not to come in the last day. (Most medical students know this is a taboo, but I did it anyways. This shows you how much I could not stand this group.) Of course, the answer was “no.”

Bottom line is: no matter which rotation you go to, the doctors you work with play a huge role in how awesome or how crappy the rotation will be.

How to Get Through Surgery Rotation in One Piece

First, you want to avoid getting chewed up too much. So definitely find out which doctors are mean and which are nice. Then avoid the mean ones like the plague. One of the interns actually avoided the whole surgical group until it was time to go.

Second, stop kissing butt. Butt kissing usually leads to revealing too much information that can harm you and the class. Let me give you an example. One of the requirements for my surgical rotation was to give presentations. For some reason or another, presentations took longer than expected. Therefore, administration decided to dedicate a half day of rotations for presentations. That means it was half a day less of seeing that loathsome surgical group. All medical students were happy. No one enjoyed being there. That morning, two hours, before presentation, one of the medical students was trying too hard to kiss where the sun doesn’t shine. He revealed that we had free time after our written exams, at a later date. The program director then had that student contact the rest of the students to tell us not to leave the hospital. Our half day has been reverted to a full day. The post-exam break is now for presentations. In essence, I lost a full day (the original half-day for presentations and the post-exam break).

Third, practice suturing. Knot tying is an important skill to have, especially if you want to do surgery, emergency medicine, or family medicine. This also allows you to help out more besides holding retractors.

Fourth, know your gastrointestinal anatomy. 90% of general surgery involves the GI system. Knowing, at minimum, the basic anatomy will help you not appear dumb. In surgery, looking dumb will get you punished.

Fifth, get as much sleep as you can. Between the long hours in the hospital and catching up on your readings, it will be easy to sacrifice sleep. Therefore, do everything you can to get some sleep. Or else you may fall over onto the sterile field in the operating room and incur the wrath of the surgeon. Not good.

Books for Surgery Rotation

It is recommended to read at least one book for whatever rotation you are on, so you can prepare for the standardized post-rotation exam (i.e. shelf exam or COMAT).

Just as a side note, if you are taking the COMAT, check out this excellent resource straight from the makers of the COMAT. It will show you which topics are tested and will give you a short practice exam — all for free!

For this rotation, I used two main books: Dr. Pestana’s Surgery Notes and Surgical Recall.

Dr. Pestana’s Surgery Notes (aka Kaplan USMLE Step 2 CK Lecture Notes – Surgery)


If you had to pick only one book, get this one for surgery. The main section of concern are the surgical vignettes. That section gives you short clinical cases. And bases on the cases, you will learn how to diagnose and manage the disease. What sets it apart from other books is the way the cases are presented. Some of the cases will be the same, except for one difference. And based on that difference, it will lead to a whole different diagnosis and management. Basically, you will learn a lot without going through the pain of reading a dry, boring textbook.

Dr. Pestana’s Surgery Notes is by far the best resource to use when preparing for the surgical shelf exam or COMAT.

Surgical Recall


This is another good book to have in your white coat pocket. Do you need it though? No. But it will help you prepare for the pimp questions. The more questions you get right, the smarter you will look.

The style of the book is basically in question and answer format. It will not delve into explanations. If you are the type of person who memorizes and regurgitates, this book will be excellent for you.

Let me give you a few sample questions and answers:

  • What is the most common indication for surgery with Crohn’s disease? Small bowel obstruction (SB).
  • What is the most common type of breast cancer? Infiltrating ductal.
  • What is the most common site of breast cancer? Upper outer quadrant.
  • What is the most common vessel involved with a bleeding duodenal ulcer? Gastroduodenal artery.

Kaplan Medical USMLE Step 2 CK Qbook


If you refer back to my study strategy, you will see that doing practice questions is important for doing well on exams. Although this particular book is not mandatory, especially if you are already subscribed to an online question bank, this is a good and inexpensive source of questions, answers, and explanations. Personally, I got this book because I did not have a subscription to a question bank yet. Therefore, this book is the next best thing. This book has questions for internal medicine, obestrics & gynecology, pediatrics, psychiatry, and surgery. If you decide to get this book, it will help prepare you for the core rotation exams.

Good luck and godspeed. I hope you make it out in one piece.

This article is part of the How to Survive Medical School series. Click on the link if you want more tips and hints about surviving academic hell.

Comments

  1. Alex, I am a nursing student. Last week I spent a whole day in ER and a whole day shadowing a respiratory therapist. Both the nurse and the RT were super nice, laid back, and enthusiastic to teach me. I felt so blessed and wanted the day not to end. Weeks ago, I had a nurse who said directly to me: “I don’t like students at all. You slow me down and make my day tiring.” Surely, they are stressed and tired, yet as students we are also tired of school work and clinical rotation as well. I totally disagree with the idea of dumping one’s trash onto another person, especially those more inferior. Sorry for your not-so-nice experience in the surgical rotation.

    • Alex Ding says:

      Hey Cang,

      Thanks for sharing about your experience. If a doctor said that he does not like having students around, I would offer to go home. This way, I won’t waste his time and I won’t waste my time.

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