Surgery Clerkship: 150 Biggest Mistakes and How to Avoid Them

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ISBN: 9780972556132 | 0972556133
Cover: Paperback
Copyright: 7/1/2005

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Baylor College of Medicine, Houston, TX. Discusses the most common mistakes made in surgical clerkships. Provides individual error scenarios with tips to correct the situation. Also offers a checklist for pre-rounds, templates for notes, and a step-by-step guide for patient presentation. For medical students. Softcover.

About the Editor

xii

About the Authors

xiii

Foreword

Preface

xvii

Prerounds

Setting aside too little time for prerounds

(2)

Incomplete data gathering during prerounds

(2)

Information gathered during prerounds is not written down

(1)

Not being intimately familiar with the patient's chart

(1)

Not tracking down lab or examination results

(1)

Not offering to help your residents preround on patients even if they're not your own

(1)

Not knowing which patients you will see in the morning

(1)

Being short with the ancillary staff

(1)

Spending little or no time talking with the patient

(1)

Not examining the patient thoroughly

(2)

Withholding patient information from the intern or resident

(2)

Morning Work Rounds

Being unfamiliar with the resident's expectations for you during morning work rounds

(1)

Arriving late for work rounds

(1)

Oral patient presentations are not brief and concise

(1)

Presenting patients in a disorganized fashion

(6)

Wasting the team's time while you take down a dressing

(1)

Correcting house staff on rounds

(1)

Not knowing your patient

(1)

Being afraid to say, ``I don't know''

(1)

Not working with the other students as a team

(1)

Not making a to-do list

(1)

Not paying close attention to what the residents say about your patient during work rounds

(1)

Orders and notes are not signed during work rounds

(1)

Not understanding your responsibilities during afternoon rounds

(2)

Preoperative Note

Not knowing how to write a preoperative note

(1)

Writing the preoperative note at the wrong time

(2)

Not having the structure or template of the preoperative note handy

(1)

Being unclear on what to write in the preoperative note

(3)

Not realizing that something important is missing prior to surgery

(3)

Not helping your intern write other patients' preoperative notes

(1)

Not receiving feedback on the quality of your preoperative notes

(2)

Brief Operative Note

Not knowing how to write a brief operative note

(1)

Not having the template of the operative note handy

(1)

Not knowing what to write in the operative note

(2)

Not knowing how to describe operative findings

(1)

Not knowing what to write under ``complications''

(1)

Not writing the postoperative orders

(1)

Not having a mnemonic for postoperative order writing

(1)

Not knowing how to write the postoperative orders

(5)

Not paying close attention as the end of the case nears

(1)

Postoperative Note

Not writing the postoperative note

(1)

Not having a template for the postoperative note

(1)

Not knowing what to write in the postoperative note

(3)

Not looking at the wound dressing at the post-operative check

(1)

Not paying attention to postoperative level of consciousness in an extubated patient

(1)

Answering questions that should be left to the resident or attending surgeon

(1)

Failing to check the lab test/EKG results (if they are done) as soon as they are back in the PACU

(3)

Daily Progress Note

Using an improper format

(4)

Note is too long

(1)

Not finishing the note in the morning

(1)

Incorrectly numbering the postoperative day #

(1)

Not including the patient's medication list

(1)

Writing an incorrect plan

(1)

Not adding information as an addendum

(1)

Scribbling out errors

(1)

Making premature diagnoses

(1)

Not writing the procedure note

(2)

Operating Room

Not attending the operating room orientation

(1)

Not paying close attention to what is said and done during the operating room orientation

(1)

Not being in the operating room every day

(1)

Finishing the rotation without seeing the core important cases

(1)

Not seeing trauma surgery

(1)

Not knowing what operations you will be seeing the next day

(1)

Not reading about the case the night before

(1)

Not preparing for your attending physician's questions appropriately

(2)

Not knowing what sources to read

(1)

Not reviewing the patient's chart before surgery

(1)

Not eating before surgery

(1)

Leaving valuables in the call room or in the OR locker room

(1)

Not going to the bathroom before surgery

(1)

Not taking your pager off before the case starts

(1)

Not wearing the proper surgical attire

(1)

Not covering your hair properly

(1)

Not wearing your mask appropriately

(1)

Not protecting your eyes

(1)

Not wearing appropriate footwear

(1)

Not following institutional policy regarding the wearing of scrub suits

(1)

Not introducing yourself to the operating room team

(1)

Not informing the surgical attending or senior resident of a mandatory conference

(1)

Scrubbing when your help is needed in the operating room

(1)

Not offering to put in the Foley catheter or prep the patient

(1)

Not asking for help during your first scrub

(1)

Not performing the surgical scrub properly

(2)

Not knowing what to do after you scrub

(1)

Not knowing where to stand at the OR table

(1)

Not doing your part to maintain the sterile field

(1)

Moving around too much

(1)

Not notifying the team if your surgical gloves become contaminated

(1)

Arguing with the scrub nurse or surgeon when they say you are contaminated

(1)

Not involving yourself in the case

(1)

Being discouraged if the surgeon is giving you a hard time or ``pimping'' you

(1)

Not answering the question you were asked

100

(1)

Asking a question at an inappropriate time of the case

101

(1)

Not understanding the attending or resident physician's request

102

(1)

Not retracting properly

102

(1)

Not cutting the sutures the correct length

103

(1)

Loud talking or socializing in the operating room

104

(1)

Paging the resident when he or she is in the operating room

104

(1)

Not offering to answer the resident or attending physician's pager

105

(1)

Not knowing what to do if you feel faint

105

(1)

Not knowing what to do when you have to sneeze

106

(1)

Not writing the operative note immediately

106

(1)

Not accompanying the patient to the Post-Anesthesia Care Unit (PACU)

107

(1)

Not seeing the patient whose surgery you took part in before afternoon rounds and before going home

107

(1)

Not familiarizing yourself with knot tying and suture techniques early in the rotation

108

(1)

Attending Interactions

Not asking other students or residents about your attending

109

(1)

Not showing initiative

110

(1)

Not being confident

111

(1)

Not answering questions appropriately

111

(1)

Not asking questions appropriately

112

(1)

On Call

Complaining about the call schedule

113

(1)

Being unfamiliar with on-call responsibilities

114

(1)

Being unenthusiastic

115

(1)

Missing out on the action

116

(1)

Not seeking ways to help

117

(1)

Not writing preoperative and postoperative notes

118

(1)

Not going the full distance with the evaluation and management of a new patient

118

(1)

Not obtaining a complete history on newly admitted patients

119

(1)

Not performing a complete physical examination on newly admitted patients

120

(2)

Not gathering the laboratory/imaging test data

122

(1)

Not understanding the treatment plan

123

(2)

Not writing the admission orders

125

(3)

Not relaying information accurately

128

(1)

Not taking advantages of opportunities in the SICU

129

(1)

Not participating in the evaluation and surgery of trauma patients

130

(1)

Surgical Oral Examination

Not being prepared for the examination

131

(1)

Not knowing the format of the oral examination early in the rotation

132

(1)

Not knowing what topics to prepare for

133

(2)

Not understanding the grading process

135

(1)

Assuming that you will easily be able to express your thoughts

136

(1)

Not considering the importance of your presentation

137

(1)

Not having a strategy for the oral examination

137

(3)

Letting your anxiety overwhelm you

140

(1)

Not being aware of your own nonverbal communication

141

(1)

Not listening to the question asked

142

(1)

Answering the question without thinking

143

(1)

Answering a question with a question

143

(1)

Speaking inappropriately

143

(1)

Answering a question when you truly don't know the answer

144

(1)

Thinking you can ``read'' the proctor

144

(8)

Studying for the Written Examination

Underestimating the importance of the written examination

152

(1)

Not preparing for the examination using the right resources

153

(1)

Delaying examination preparation

153

(1)

Letting your clinical performance slide as the examination nears

154

(1)

Reading only about general surgery

155

(1)

Not developing a reading plan or schedule

156

(3)

Not pacing yourself

159

(1)

Not reading the question first

160

(1)

Not reading each answer option

161

(1)

Panicking

161

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Surgery Clerkship: 150 Biggest Mistakes and How to Avoid Them

Summary

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Supplemental Materials