Category Archive: General Surgery Rotation

Best Books and Resources for the General Surgery Rotation

 

This post is part of our series on the best books and resources to help you perform well on your third year rotations and shelf exams. Also check out our lists for clerkships in Internal MedicineFamily MedicineOB/GYNGeneral SurgeryNeurologyPsychiatryPediatrics, and Emergency Medicine. You can also check out our complete list of "Best Books" lists for medical students here

Background: Clerkship Grades

At the beginning of each of these clerkship lists there are a few things I must say. First, your grade on clinical rotations will depend on both your clinical performance and your performance on a shelf exam at the end of the rotation. While it is true that how you work with your teams and patients will play into your evaluation, there is no denying that your knowledge of the subject matter is, by far, the most important part of your final grade because it directly affects both of these two areas of evaluation. As a resident, I currently find myself filling out medical student evaluations every week. There are very few 'incredible' medical students and very few 'terrible' medical students. The vast majority of you (~95%) fit into the "good and easy to work with" group; the only thing you have to set you apart from others is your knowledge base. You have no alternative but to study! First Aid for the Wards is a great resource to understand the dynamics of your clinical rotations, I highly recommend it.

Essential Resources

The resources I will describe in the clerkship lists are books and online question banks. From the onset let me point out two indespesible resources that I will not list for each rotation individually.

  • First, I consider a great online question bank essential. Both Kaplan and USMLE World are very good products. I highly recommend purchasing a one year subscription to one of these USMLE Step 2 question banks. As you complete your third year rotations, these question banks will prepare you for 1- your clinical duties, 2- your rotation shelf exam, and 3- the USMLE Step 2 during your fourth year.  
  • Second, online review materials (e.g. Medscape, UpToDate, etc.) are essential resources to prepare for your patients in the hospital. The books and question banks can never provide the type of in-depth detail about disease processes that you will need to learn how to properly take care of your specific patients. To be a great medical student, you must prepare more profoundly for the diseases you are encountering personally in the hospital.

Book Series for Third Year

Medical students are not all made the same; we are all very different learners. There are a number of companies producing review materials for third year medical students, each with a slightly different focus. Each of these companies produce a different book for each clerkship. Interestingly, some companies' books are rated higher in some clerkships than others. If you find a product that works for you, consider sticking with it during your third year even if that product is not 'rated' as highly for a specific clerkship. Below are a few of the review products and their features.

  1. The Case Files Series: A unique teaching model; the Case Files series introduces a number of important clinical cases and follows them up with clinical pearls and important concepts. For students who need vivid clinical situations to remember factoids and concepts, this is a great series. (Case Files Surgery)
  2. The PreTest Series: The PreTest series is a classic question bank format with questions and detailed explanations. As I previously mentioned, I believe there is no substitute for a great question bank. While an online resource (USMLE World or Kaplan) can be more robust and mobile, a good question book is still a great option. The PreTest series produces a couple fantastic question banks. (PreTest Surgery).
  3. The BluePrints Series: The BluePrints series has a beautiful format that is very easy to read. The text is laid out in a bulleted lists, but with more details and descriptions than the First Aid series with which most students are familiar. I think very highly of these review books. (Blueprints Surgery).
  4. First Aid Clerkship Series: The First Aid series well known to most students also produces review books for third year clerkships. The content is similar to what students are used to, bulleted lists of high yield information. While I highly recommend many of the First Aid review books for USMLE Step preparation, the books are not quite as widely read and recommended for clerkships. (First Aid Surgery).

Best Books for General Surgery Rotation

So, we can agree that books are not sufficient for success on your clerkships, but they are still an incredible resource that you should tap into. Let's review the best books and resources for your General Surgery rotation. These lists come from both my experience and also from one medical school's annual survey of its 250 graduating medical students who try to detail which resources were the most useful on their rotations.

The General Surgery clerkship is unique in that the most highly recommended books and resources are completely different than for all other rotations. In fact, none of the book series mentioned above are very highly recommended for the general surgery rotation. One reason for the difference is that you will not only have to prepare for the shelf exam and hospital rounds, but you will also need to prepare for pimping in the OR, which is a total different animal. Below are some resources that will help

 

1. Dr. Pestana's Surgical Notes:

Dr. Pestana's book started as a pdf document that was passed around nearly every medical school in the country. His insight into high yield topics in general surgery is unmatched. His clinical scenarios are all relevant and his explanations are all clear and concise. I consider this a must-have resource for medical students.  


 

2. NMS Surgical Casebook:

One of the most widely used clinical resources, the older edition of the NMS Casebook is known and respected by almost every graduating medical student. The reception of the new edition (linked to the right) is still to-be-determined. The casebook portrays clinical scenarios commonly seen in the OR and on the post-operative floors. It is a great companion to the NMS Surgery Textbook, which is a more complete review of clinical and operative general surgery.

3. Surgical Recall:

While question banks and text books will help students prepare for the clinics, wards, and shelf exam, they are not great resources when preparing for the operating room. I found Surgical Recall to be an excellent resource to prepare for intra-operative pimp sessions.


 

4. Case Files Surgery:

The CaseFiles Surgery volume is a quick read and could be a very good resource at the beginning of your rotation so that you get a broad introduction to common surgical problems. However, it is not sufficient for the shelf exam and will not prepare you very well for specific operating rooms.


 

Top Ten Books for Surgical Interns

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

The surgical internship is unique in that you will care for the full spectrum of patients: acute surgical patients, post-operative patients, patients with chronic illness, and very sick patient in the ICU. The surgical intern is truly a "Jack-of-all-trades" physician and must be able to reconcile huge med lists, manage diabetes, identify an acute abdomen, and take care of acute electrolyte changes in the ICU.

These are tall orders for a newly minted doctor. And don't forget, after 7am you will likely be the only one on the floor while the rest of your team heads to the operating room. Having the right books is one easy way to calm some of the inevitable anxiety. After much discussion with interns and residents at my last two hospitals, I have compiled the following Top Ten Books for Surgical Interns. These books are also great resources for preliminary surgery residents, or other surgical supspecialistis completing a general surgical internship. Most of the general surgery residents I spoke to agree that this list remains the same into their entire residency. Good Luck!

  • Updated May 2015

1. The Mont Reid Surgical Handbook:

The Mont Reid Handbook is a great reference tool to keep in your pocket or on your phone. It was written by a group of surgical residents and is very high yield. It will cover the majority of issues you run into while managing the floors during a surgical internship. It is also great for reviewing for OR cases…if you get to see any during your first year.

2. Surgery On Call:

Surgery On Call is another great pocket reference. The goal of this book, however, is more in the initial evaluation and treatment of surgical patients. The quick-reference format is great for a quick consultation. Some interns also suggest Surgical Recall , which has a similar format but is geared more towards 3rd and 4th year medical students. 

3. A Textbook: Cameron, Current Surgical Therapy:

Every surgery resident, even surgical interns, will benefit from a great surgery text. Many of you will be provided a text at the start of residency, so ask your department before investing hundreds in one of these books. Cameron's Current Surgical Therapy is the highest rated by surgical residents. However, there are other great options. Greenfield's Surgery is well-regarded and cheaper than Cameron's. There are also many people who swear by the Sabiston Textbook of Surgery

4. Tarascon Pocket Pharmacopedia:

While we all have access to online pharmaceutical indexes during residency, I agree with most interns and residents that a pocket manual like this great Tarascon book is far faster and more reliable than most online resources.

5. The ICU Book:

You really should get an ICU book. You can get through your first month as an intern in the SICU or MICU without one of these books, but they make your life so much easier that it is just not worth it. Even if you just read through it a few weeks before starting in the ICU, the information will be fresh on your mind and will help you a lot. This is the ICU book I used, it addresses both medical and surgical intensive care issues. Many residents also like The Little ICU Book

6. The Washington Manual Internship Survival Guide:

This is a lesser-known internship manual written by the same people who developed the highly rated medication reference, The Washington Manual of Medical Therapeutics. Not as well known as the Mont Reid manual, this is a book from a similar mold with a small but vocal cult-following.  

7. Zollinger Atlas of Surgical Operations:

A surgical atlas is the best way to learn the anatomy and prepare for pimping in the OR. A great surgical atlas will become one of your most important references during residency. If you are a general surgery resident, Zollinger's is the go-to atlas for most residents. 

8. Operative Dictations in General Surgery:

Dictating operative notes is a necessary evil. It has to be done, and it has to be done well for documentation purposes. As the low man on the totem pole, the job of dictation will fall on you. This is a highly recommended book to help interns and residents early in their career. I have a number of procedure note templates available on this website.

9. The ABSITE Review (FISER):

Many surgical interns will complete residencies in specialties other than general surgery. For those of you moving on the general surgery after your internship, you should start studying for your ABSITE early. I know you are incredibly busy in the hospital, but when you have a minute you should keep an ABSITE review book and/or question book handy. The Fiser review comes highly recommended. Another book that many residents recommend is ABSITE Slayer.

10. Old-School and Out-of-Print:

After discussing books for surgical internship and residency with many people, there were two books that were mentioned many times but are no longer in print: The Cleveland Clinic Guide to Surgical Patient Management and The Surgical Intern Pocket Survival Guide . These two books come as high or more highly recommended than every other book on this list. Some residents say these were the most used books in their white coats. Unfortunately, you can no longer buy either of them new, but there are many used options.  

 
 
 

Spotlight Interview: Why Did You Choose Urology? (OSU Resident)

A Urology Resident’s Perspective: From an interview with a urology resident The Ohio State University Medical Center  in Columbus, Ohio.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Urology?
I knew that I was attracted to surgery, but I was not interested in living a “surgeon lifestyle.”  Many doctors, including surgeons in other specialties, recommended during medical school that I check out urology.  Urology was not on my differential and the thought of dedicating my life to the urinary tract did not seem appealing.  I was convinced to do a 2 week surgery subspecialy rotation in urology.  I was amazed at the breadth of surgical procedures they performed.  I also enjoyed all the different equipment (or toys) that they utilized.  There was also a lot of variety in clinic between medicine and office procedures.  I appreciated the fact that urologists worked hard, but most days were still done at a reasonable hour.   This allowed the urologists to maintain a healthy balance between work and life outside the hospital.  Probably, the deciding factor was how genuinely happy the urologists were and when asked, all of them stated they would choose urology if they had to do it all over again.

 

  • Describe a Urologist’s typical work day?

The work week is usually split fairly evenly between clinic and OR.  I would say that most urologists have around 2 OR days and 3 clinic days, although many clinic days may have time dedicated to office procedures.  Obviously, the clinic days are going to be more routine office hours.  OR days vary a lot depending on what type of cases you perform.  Most procedures are outpatient and relatively short.  If you plan to do a lot of cancer surgery then you will do some longer cases and therefore will have some evenings spent operating.

 

  • What type of lifestyle can a Urologist expect?  

It is still a surgery field which means you still have early rounds due to early OR cases.  I feel that residency hours are comparable to other surgery fields, with the main difference maybe being home call for urology versus in-house call for many other fields.  I feel there is a light at the end of the tunnel though.  In practice, most days will have office-hours type of schedule.  A lot depends on what types of cases you decide to do and how the call is split up.  In general, there are less emergent surgeries in urology than most other fields.  If you are at a busy hospital there still may be ER consults and inpatient catheter issues that will need to be addressed in the middle of the night.  I think that most nights, even on call, you can expect to get a decent amount of sleep.  Relative to some surgery fields, you should have adequate time to spend with family and doing hobbies during the evenings and weekends.

 

  • What is the average salary of a Urologist?

Overall, probably between $200,000 and $600,000 with starting salary between $200,000 to $400,000.  A lot has to do with private practice versus academics and how saturated the specific market is.  I think most academic urologists will make between $200,000 to $300,000, but with certain bonus/incentive packages may eventually make more.  If you are starting off in a bigger practice in a more competetive location, you will likely start off closer to the $200,000 range, but with time can build up your practice and eventually be making greater then $500,000.  There has also been a trend towards hospital employed urologists.  These hospitals will often provide higher starting salaries (e.g. closer to $400,000), but may have more of a ceiling on how much you can earn from there.

 

  • What is the job market like for Urology?

Most of the big, destination type cities are relatively saturated.  Having said that, you can likely get a job just about anywhere but you may just have to take a big pay cut.  There are many relatively rural hospitals that are desperate for urologists and will pay good money to lure you out there.  I would say in general that the job market is good, but you may need to have some flexibility on where you want to end up practicing.

 

  • What can you tell us about Urology Sub-specialties?

Urology fellowships are 1-2 years.  As opposed to the trend in many other surgical fields, you definitely do not need a fellowship to get a good job.  Most residents will only do a fellowship if they want to do academics or if there is a specialty field that they feel they did not get adequate exposure to during residency and they desire extra training in.  In some big cities, fellowships may give you a marketable skill, but most fellowship trained urologists will still practice general urology with maybe a slant towards that specialty.  If you really just want to do one specialized field and not other parts of urology, then academics is likely your best option.

 

  • What are the potential downsides of Urology that students should be aware of?

Urology is a tough surgical residency.  With any type of surgery comes complications and stress.  Although call may be better than some surgery fields, there are still going to be emergent cases or patients crashing in the middle of the night and on weekends.  You are dedicating yourself to the urinary tract which means a lot of bloody urine and prostate exams.  Everytime you tell people what field you’re in you have to answer the question, “why urology?”

 

  • What else would you tell medical students who are considering Urology?

If you want variety and enjoy being busy then this is a good field to consider. Compensation is definitely on the higher end which is a bonus!

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Spotlight Interview: Matching in General Surgery

 

A General Surgery Resident’s Perspective:  From an interview with a general surgery resident at Orlando Health in Orlando, FL

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the general surgery match?

Moderately difficult. The average USMLE Step 1 score is usually in the high 220s, but higher for the sought after programs.

 

  •  What must a student do to match well in general surgery?

Your USMLE Step 1 score is the most important factor. Letters of Recommendation are very impotant and some should come from surgeons you have worked closely with. If you are interested in a research institution then research publications and presentations are very important.

 

  • What are residencies looking for in a general surgery applicant?
They are looking for someone who is Intelligent; they use Step 1 scores to establish this. They are also looking for someone who is passionate and hard-working; they can learn this through the activities you list and from the things mentioned in your letters of recommendation. It is important to be easy to work with, you can show this to programs during your interview.

 

  • What should students look for in a general surgery residency?

From a training standpoint, I think that surgical simulation experiences and structured education lectures/curriculum are something that every applicant has to be aware of. These experience are paramount in your surgical training. As you probably know, operative experience volume and variety is one of the most important factors (i.e. how many mastectomy vs whipple cases). You should know these statistics about each of your programs of interest.

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Letters of recommendation should be from faculty that can speak to your strengths in clinical decision-making and surgical skills. Personal statements should not be about how you always wanted to be a surgeon, but why you decided to be a surgeon. Rank programs that provide you with a high operative experience and well-defined simulation/education curriculum

 

  • What do you wish you knew before application/interview season?  

Be sure to prepare your  letters of recommendation early. Plan to interview at about 10-15 programs. If you plan to interview at highly competitive programs, you might need to plan on a bit more interviews.

Editor’s Note: I 100% agree with preparing your LOR early.  Many of the attendings are extremely busy and 1 month notice may not be enough. Start asking at the end of your third year if you find individuals who could write great letters.

 

  • What other advice do you have for students applying to general surgery residency?

The best advice I ever received about deciding to do general surgery was “If you can’t do anything but general surgery and be happy as a physician then you should do surgery. Otherwise do the other specialty”. General surgery is a much more family-friendly specialty than it used to be. The egos and personalities that used to predominate the specialty are gone, surgeons are expected to be calm and mild-mannered today and exist well with their non-surgical counterparts. The best part of being a surgeon is being able to diagnose and treat the problems our patients face. When all other options fail and other specialties are uncertain what to do they will consult a surgeon to help, so you will be the go-to person where-ever you practice

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

Spotlight Interviews: Why did you choose general surgery?

A General Surgery Resident’s Perspective: From an interview with a general surgery resident at Orlando Health, in Orlando, Florida.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to General Surgery?

I appreciate the combined operative and medical management of patients. Surgeons make definitive management of patient issues. There is a great variety of operative procedures. As a general surgeon I am able to care for both long and short term patient management scenarios. There is a great deal of job opportunities and availability. I enjoy team-based patient management.

 

  • Describe a General Surgeon’s typical work day?

I usually wake up at 0400,I am at hospital by 0500 to round on patients until about 0700. I will be in the OR from 0700 until about 1600 with intermittent 30-60 minutes breaks between cases to eat, follow-up on patients, and see new consults. From 1600-1800 we follow-up on outstanding patient issues and setup for following day. On good days, I return home and from 1800-2000 I study for following day cases and current patient problems. On non-operative days, simply change the OR times  to clinic from 0800-1600.

 

  • What type of lifestyle can a General Surgeon expect?  

As a general surgeon I work weekends at least 2-3 times per month. The amount of free time you will have is extremely dependent on your sub-specialty choice. Private practice surgeons enjoy significantly more free time while surgeons in academic practice spend more time with research and have less operative/clinic time generally. Call is usually taken for 24 hours periods and you will be working most of the day and night. Some surgeons have a tendency to scheduling elective cases during their call days, but this depends on how difficult your call is.

 

  • What is the average salary of a General Surgeon?

The overall salary of a surgeon is highly variable amongst sub-specialties, typically  between $250,000-$500,000.

 

  • What is the job market like for General Surgeon?

There is no lack of general surgery positions. I would say they are extremely available for both private practice and academic positions. There is some variability among sub-specialties. However, overall, we are one of the most high recruited specialties.

 

  • What can you tell us about General Surgery Sub-specialties?

Residency for general surgery is 5 years mandatory and more commonly 1-2 years research years during PGY2 or 3. Therefore, many general surgery residencies last 6-7 years before fellowship. Fellowships typically last 1-2 years. Subspecialties have more call and higher salary. Additionally, sub-specialties are generally in more demand than general surgeons.

 

  • What are the potential downsides of General Surgeon that students should be aware of?

The schedule is less flexible due to emergent surgical problems. Surgical shift hours are not reliable and typically cases will be delayed or run over and require staying at the hospital beyond a call or shift. This leads to a schedule that can be variable. Training programs are not as “intense” as they were historically, although there are still high expectations of surgical residents. There are not many other residents/doctors who work as hard as general surgeons.

 

  • What else would you tell medical students who are considering General Surgery?

One thing students should realize is that there is more peri-operative management being handled by hospitalist services for elective surgical problems. Therefore, some of the duties and responsibilities of a surgeon 20 years ago and being placed in the hands of non-surgeons. Additionally, surgical critical care services are beginning to  limit the medical management requirements of general surgeons.

 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Top Ten Books for Third Year Medical Students

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3. 

Choosing a top ten list for the third year of medical school was a lesson for me in biting off more than one can chew. I will soon be compiling top ten lists for each of the core rotations in medical school, which will be a more manageable list. However, there are common themes during this very important year of training, and you will be testing the waters of many potential future specialties. I think these books will help with these endevours. 

  • Updated April 2015

1. First Aid for the Wards:

Beginning the third year of medical school is a daunting task. I shook like a little kid the first time I had to present on rounds. In retrospect, I wish I had read this book before I ever started third year. It provides great advice about prerounding, rounding, presenting patients, and working with your clinical team. It also gives rotation specific advice for each of the main third year clinical clerkships.

2. Pocket Medicine:

I consider pocket medicine a must-have for all students and residents. I used it during medical school and am still using it in residency. It highlights all the most common clinical illnesses and presentations. For each illness it describes the clinical presentation, signs and symptoms, diagnostic tools, and treatment plan.

3. Maxwell Quick Medical Reference:

A small book with a big role. Nearly every medical student I know carries this book in their white coat. It contains clinical pearls and references that are very high yield. Additionally, it contains sample notes (progress, transfer, procedure, admission, etc).  It is about the best $10 you can spend.

4. Case Files:

The Case Files Series (Amazon link) is my favorite clerkship study series. Similar to the Pretest Series (#5) and the Blueprint Series (#6), Case Files publishes one book for each medical student clerkship. The book teaches principles through a series of 50-60 cases.  After each case is presented, the relevant clinical teaching points are discussed and followed with a series of questions. For my style of learning, this was the ultimate study tool during third year. I particularly recommend Case Files Neurology and Case Files Family Medicine. .

5. PreTest:

Another series of books for each medical student rotation, the PreTest Series (Amazon Link) are simply question banks in print form. Their questions are very good and hit on relevant material. Although I prefer USMLEworld as a straight question bank tool, the Pretest books allow you to always have questions at your side for bus rides, downtime at the hospital, etc. Along with many medical students, I particularly recommend PreTest Pediatrics, which was eerily similar to the shelf exam.

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6. BluePrints:

The BluePrints Series is a third series with one book for each medical school clerkship. Unlike the case-based presentation of Case Files and the q-bank format of PreTest, the Blueprints series are more like textbooks. They aim to teach the most pertinent clinical facts without becoming too dense. Each book is about 300 pages and contains a wealth of information…if you can get through it. Blueprints Obstetrics and Gynecology is widely considered the most useful; I used it and did very well on the shelf.

7. Surgical Recall:

If you are interested in surgery or just interested in obtaining a good grade in your surgery rotation, you need to know what is going on in the OR. Surgical Recall provides step-by-step details of surgical procedures including surgical indications, pre-operative management, intra-operative management including a walk-through of the surgery, and post-op management. It will really help you shine in the OR.

8. First Aid for the USMLE Step 2 CK:

Yes, you will probably find a 'First Aid' book in each of my Top Ten book lists. This is because I have found them to be the best tool at solidifying the most important points of each phase of medical school. During third year the First Aid for Step 2 CK (Clinical Knowledge) was a great way to make sure I knew the most important facts. It is certainly not sufficient to study alone.

9. Dr. Pestana's Surgery Notes:

Dr. Pestana's notes are an absolutely necessary resource for students on the Surgery rotation. The notes provide real-world examples that combine pathophysiology with surgical patients. Complications, surgical decision making, and post-operative care are all addressed. I was shocked at how high yield these notes were when I took the shelf exam.

10. Step-Up to Medicine:

You will also find this book at the top of my list for the the internal medicine rotation. However, it is so good that I thought I should mention it here too. The book comes highly recommended by nearly every student that has ever used it. It will give you a great base to study from and find out what you need to study more.

 
Honorable Mention:
  1. I can not create a list of study tools for third year medical students without mentioning USMLEworld.  After using many Q-banks, many question books, and other resources, I have concluded that USMLEworld provides questions most consistently similar to the real shelf exams and boards as well as provided the clearest explanations.
  2. Success on the Wards: 250 Rules for Clerkship Success is a highly rated book for third year students
  3. 250 Biggest Mistakes 3rd Year Medical Students Make and How to Avoid Them is written as the same authors as "Success on the Wards" and also comes highly recommended.
  4. The Ultimate Guide to Choosing a Medical Specialty. Really, this books should be in the Top Ten.  I left it off because it is not specifically for third year medical students. However, it is one of the best resources available for deciding what is important to you in a specialty, and comparing variables across all medical specialties. I highly recommend it.
 
 
 

Is the Patient’s Device Safe for MRI?

MRIsatety.com is a great resource for medical students, residents, and all medical personnel.  We all know that when a patient has a pacemaker from 2004 that they can not get a thoracic MRI. However, what if the patient had a recent shoulder replacement? What if the patient has a port for chemotherapy? What if the patient had recent spinal surgery? No matter what the circumstance, you can search this website for the patient’s device and find out if it is safe for an MRI.

The main website is…
http://www.mrisafety.com

Or, the searchable list of implantable devices can be found directly at…
http://www.mrisafety.com/list_search.asp

The list of all searchable products includes:

  • Pumps
  • Aneurysm clips
  • Bone and Nerve stimulators
  • Cardiac Pacemakers and AICDs (defibrillators)
  • Breast and other soft tissue implants
  • Coils, Filters, Stents, Grafts
  • Dental Implants and Devices
  • Catheters
  • Clips
  • Foreign Bodies
  • Ocular Implants, lens
  • Sutures
  • Etc.

 

Pre-operative Clearance Checklist

A frequent question in the outpatient setting is whether or not a patient is optimized for surgery. There are a number of things that a physician must check in order to properly send a patient back to a surgeon with a gold star. I recently used the Johns Hopkins Internet Learning Center (HopkinsILC) to study the basic pre-operative evaluation and I highly recommend it (requires access from your school or hospital, many hospitals have access, ask your librarian).  There is a great review pdf available from HopkinsILC which details some of the highlights of the lesson.  Below I will summarize some points from the pdf. To learn more, you should ask for access to HopkinsILC, it is a great resource.

 

  1. If the patient has any active cardiac issues, surgery should be postponed.  This includes…
    1. Recent myocardial infarction (<30 days)
    2. Active cardiac disease (unstable angina or worse)
    3. An uncorrected arrhythmia
    4. Severe aortic stenosis

 

  1. The patient must be able to complete 4 or more ‘metabolic equivalents of task’ (METS).  This includes
    1. Climbing a flight of stairs
    2. Walk for 30 minutes
    3. Play tennis, bowling, or other more intense sports
    4. Able to vigorously clean a house (scrub floor, move furniture)

 

  1. There are a few medications that must be stopped prior to surgery. Some examples (not an exhaustive list) include…
    1. If the patient is on blood thinners (coumadin) or anti-platelet drugs (plavix, lovenox, etc) these may have to be stopped and the surgeon will have to be part of the discussion
    2. Diuretics, ACE-inhibitors, and ARBS are usually held
    3. Oral hypoglycemics are usually held for 1-2 days
    4. Insulin is usually decreased by 50%
    5. Sedatives are usually held

 

Again, here is the link to the pdf explaining the above points. And here is the link to the HopkinsILC website.

 

 

How to instrument tie: A video tutorial

jpatrick.net

In recent posts I highlighted some great training videos on suturing and on one and two handed knot tying. In this post I will recommend a video tutorial for instrument tying.  As with the other suturing and knot tying skills, it is very important that medical students learn early in their careers how to instrument tie.  This is the bread and butter of knot tying.  If you are proficient with the instrument tie you will impress residents and attendings and they will be much more willing to give you responsibilities in the OR.  The video below is a straight forward review and tutorial of the instrument tie.  As with all other knots, remember that a square knot is not complete until you have made two opposing throws; otherwise you are tying granny knots.

One and two handed surgical knot tying: A video tutorial

In two recent posts I recommended some great video tutorials for suturing and for instrument tying.  This post will focus on learning how to tie one and two handed knots in the operating room.  As with previous skills, it is very important that medical students learn to tie surgical knots early in their training.  Let me offer one experience from medical school to illustrate this fact.  This is a true story.

After finishing rounds with the residents on my OB rotation I was assigned to work in the OR with the chief of benign gynecology surgery at a community hospital.  He also happened to be the rotation coordinator and was responsible for my grade and evaluation.  The first case was an open tubal ligation. As the case was ending the attending turned to me and said, “hey, we have to close the fascia, can you tie knots?”  Luckily, I knew quite well how to tie.  I picked up the suture and threw a few two handed knots down.  My attending was seriously impressed and told everyone on the team.  He gave me a raving evaluation and spoke specifically about how I was “well prepared for the OR.” So, take it from me, learn these knots! Always remember Rule #1: tie square knots, not granny knots! Two throws are required to complete the knot. 

1. The two handed knot.  This is the knot that you will actually use in the OR. Most surgeons never tie one-handed knots and some even forbid them.  So, this should be your bread and butter. After watching a few tutorial videos I am convinced that this is the best.  It comes from the University of Texas at Houston and walks you through the basics. The audio is very good, so find some earphones. Always remember that a square not requires two throws to be completed.

2. The one handed knot: This is a more confusing knot and far less high yield because very few surgeons ever use it or expect it.  It is notoriously difficult to teach and to learn.  The best video I have found is shown below.  Unlike the previous video, there is not audio to walk you through the knot.  Rather, the knot is completed slowly and each difficult section is repeated.  Remember, you must tie two throws to make a complete square knot. This is important when tying a one handed knot because the two throws are completed using two different techniques.

Finally, there is more than one way to tie a square knot.  Here is one more video that demonstrates the two handed and one handed method clearly. Similar to the second video, there is no audio.  Go get some gloves and some suture and practice along with this video.

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