This selective in surgery is not specifically with any particular surgeon, but in the Surgery Department; however, I do organize the rotation. The following is an explanation of the objectives and requirements for the course.
The primary objectives of the rotation are:
To expose you to the working of the hospital (specifically surgery) so that you become familiar with the system.
Involves becoming familiar with StringSoft, our electronic medical records system., and finally, our digital radiographic archive system (PACS).
You are to become familiar with, and be able to look up/retrieve all appropriate case information.
To expose you to the clinical caseload and learn to use it to research/become familiar with various clinical entities and the decision-making for the surgical cases that you will be observing.
You will learn how to read the surgical schedule [the day before] so that some preparation regarding the case(s) likely to be in the OR on Tuesday afternoon can be performed. This involves reviewing the tentative surgical schedule (located on the door to anesthesia induction) and looking up the pertinent case information.
The “assignment” for Monday evening is to review, on your own, the problem being addressed surgically (textbooks, articles, internet searches, etc. and the case information at your disposal, i.e., the case Hx and PE and any diagnostic information). In this fashion, when the surgical procedures are observed on Tuesday afternoons, you will have an idea as to the reasons the procedure is being performed and what is being done; naturally, from this information/background intelligent and meaningful questions can be posed to the surgeons (faculty and/or residents). Spending time viewing surgery is a waste of both student and faculty time if you have no idea as to the problem(s) being addressed; therefore, some preparation is essential.
Tuesday afternoon is spent observing surgery; however, this can be done on any day depending upon student scheduling. Tuesday afternoon is primarily devoted to soft-tissue surgery; the Chief Resident Service also operates this day (both soft-tissue and ortho cases). In addition, both neuro and ophtho may have cases, and ortho can have some overflow from Monday. There is no requirement to stay with any particular service. As noted, there is a schedule that is filled out and posted on the door to anesthesia induction (by 5 PM) the day before (Monday for Tuesday’s cases, etc.). This schedule will need to be reviewed so that you can determine the case(s) to be operated in the PM (any questions regarding interpretation of this schedule can be directed to any of the techs in this area), thus facilitating your ability to prepare appropriately. Please be aware that the schedule can/will change, so there will be times that you have prepared for a case and it is cancelled or postponed to another day. If you have prepared for such a case, I do not view this as a problem, as you still will have (and should have) learned something with your review, so in my opinion such spent will never be in vain.
You are welcome to join the surgical rounds of any of the surgical services on Monday afternoon, where there will be a summary of the cases presented (for that service); however, there is no set time frame for these rounds – they are performed when the work is done for that service at the end of the day. I recognize this may conflict with your schedule (and be later than you wish to stay as they rarely occur by 5 PM), so it is not a requirement. Similarly, you are welcome to stay for rounds at the end of the day on Tuesday after surgery, but the same issue presents itself, and again is not a requirement.
The only requirement is to keep a log of all of the surgical procedures witnessed for the day each week. This log is to be turned in to me along with the grade sheet to be signed for you to obtain credit.
Feel free to interact with the surgeons and ask questions; however, I also ask you to use some common sense if there are intraoperative problems, generally associated with high stress, etc. Perhaps questions at these times could be held until things are back under control!
The surgical technicians also can help to familiarize you with the OR protocol. Please remember that the surgeons are within a sterile field that must not be violated. This means not getting too close to these individuals whereby they become contaminated if you happen to touch them or the surgical table(s). Also remember that the sterile surgical field involves the surgeons, the operating table (with patient) and the instrument table(s). Do NOT pass between the surgeon or any of these tables – ALWAYS go around the outside of this perimeter. If in doubt about anything – ASK!
Finally, if you have not been exposed to surgery in the past, and you begin to feel queasy, light-headed, hot, or ANYTHING out of the ordinary, you need fresh air and to lie down before you fall down! Please do not hesitate to inform any of the techs if you begin to feel a bit ill/abnormal. Trying to “tough it out”, should this occur, WILL result in your passing out and potentially injuring yourself on the way down, which we obviously would like to avoid. As embarrassing as this may seem to be, it happens to a surprisingly large number of people until they become familiar with this environment, so please understand that we are looking out for your safety.
Any questions about the rotation are to be directed to me.
Raymond K Kudej, DVM, PhD and Dip. ACVS.
Department of Clinical Sciences
Cummings School of Veterinary Medicine at Tufts University