General Surgery

This is a 4-week rotation where your time will be split between the OR, scope clinic, the ward and occasional office days. During this rotation, you will work quite independently and have a lot of freedom to make decisions about patient care. This can be very intimidating in the beginning, but as you gain more knowledge throughout the rotation, you will appreciate the amount of autonomy you have. This is a great rotation to practice your hands on skill in the OR and gain a lot of knowledge about how to manage patients on the ward.

Currently there are 6 general surgeons in Prince George; 2 of these surgeons also perform vascular surgery procedures. You will work with all of them in the OR, on the wards, and on-call. Usually, there is a family medicine resident on with you. There may also be a senior general surgery resident. Depending on whether or not you have a resident will greatly dictate your rotation. If you have a senior resident, they will give you a schedule and be “in charge” of you. If you don’t have a senior resident, you will have a lot more freedom to come up with your own schedule.

Before your first shift: If you have a senior resident visiting UHNBC, get ahold of them for instructions. If not, you're more-or-less on your own...exciting! Go check the OR slates the day before so you can prepare for the first few surgeries, and determine who is doing them. Chat with your track-mate and decide who would like to scrub in on which surgeries. Text your respective attendings and let them know you're new, and that you'd be keen to join them tomorrow. That first morning, get in there before the OR starts, get some scrubs on, meet your attending in the lounge, and meet the patient (and their chart). Usually on the first day of your rotation, you will meet with the DSSL before your day starts. It may feel overwhelming at first, but you will quickly get comfortable with the rotation.

OR: You will see a large variety of cases in general surgery. Make sure to check the slate ahead of time so you can prepare for each case. It can be useful to review relevant anatomy, indications for surgery and pathophysiology. All of the surgeons are really good about getting you involved and practicing your suturing/ hand tying. Before the case starts, you can start writing the OR note and post-op orders. Make sure to have read over the patient chart and introduced yourself to the patient before the case starts.

Scope Clinic: Sometimes there is only one OR running and there is already a learner in it, so you can go to the scope clinic instead. This is done in ambulatory care. It is recommended you spend at least one day in the scope clinic. If you consult on a patient who needs a scope, it is also a good idea to try and see their scope.

Office: Each week for one half-day (currently Friday morning), you will attend the 5th floor clinic to see general surgery consults. This is a teaching clinic run by the surgeons and is a good opportunity to see the kinds of presentations seen in office by general surgeons. Some of the surgeons chose to do ward teaching instead of this teaching clinic. You will be notified if this is happening.

Rounding: This will depend on if you have a senior resident or not. If you have a senior, you will likely split the list and round on all general surgery patients. If you don’t have a resident, you will likely just round on patients who you’ve been involved in their care (Eg: in OR or consult). However, it is a good idea to be somewhat familiar with all patients for when you are on call, as you may get ward calls about them. Rounding should be done before you start in the OR, which is generally by 7:15/7:30, so this usually means a pretty early start in the morning (you get used to it by the end).

You will have overnight call during this rotation. Your call shift starts at 7am and will end the next morning after you have finished rounding. You then have a post-call day. In the morning, you should text the on-call doctor that you are on with them and so they have your number. They will text or call you if any new consults come in. While on-call, you will see new consults and be "first-call" for any ward issues. As the rotation progresses, you will begin to gain comfort with orders you are okay writing (eg: pain meds) and what concerns you need to call your attending about. The attendings are pretty relaxed about you handling minor problems on your own.

If you are on call on Thursday, you will only be on-call until 11pm so you can attend the clinic on Friday morning. You do not get a post-call day. This is new and may change in the future.

• Have a look at how long an OR case is booked for. Occasionally, there can be some longer cases (up to 7 or 8 hours), so make sure you drink some water, have a good breakfast/snack and go to the washroom before the case starts.

• If at any point you are feeling lightheaded in the OR, DON’T WORRY! It happens all the time to people, so don’t be embarrassed. Let the OR staff know you need to sit down. They are all very helpful and will make sure you have a seat or take you to the lounge to get some food/water.

• Do "Tuck-in" rounds before going to bed while on-call. Eg. around 9-10 P.M. visit all the nursing pods on the surgery floor. Let the nurses know about your on-call for General Surgery and ask if they can foresee any issues coming up overnight for any of the General Surgery patients. This hopefully allows you to mitigate any calls in the middle of the night and should help to buy you some sleep.

• Get a patient list: there should be a master list for all Gen. Surg. patients on Powerchart. Use it to keep track of any pending labs for each patient.