Surgery Clerkship: 150 Biggest Mistakes and How to Avoid Them

by Desai, Samir P.

• ISBN13: 9780972556132
• ISBN10: 0972556133
• Edition: 1st
• Format: Paperback
• Copyright: 2005-07-01
• Publisher: Md2B

Summary

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.

Table of Contents

About the Editor	xii
About the Authors	xiii
Foreword	xv
Preface	xvii
Prerounds
Setting aside too little time for prerounds	1	(2)
Incomplete data gathering during prerounds	3	(2)
Information gathered during prerounds is not written down	5	(1)
Not being intimately familiar with the patient's chart	5	(1)
Not tracking down lab or examination results	6	(1)
Not offering to help your residents preround on patients even if they're not your own	7	(1)
Not knowing which patients you will see in the morning	8	(1)
Being short with the ancillary staff	8	(1)
Spending little or no time talking with the patient	9	(1)
Not examining the patient thoroughly	10	(2)
Withholding patient information from the intern or resident	12	(2)
Morning Work Rounds
Being unfamiliar with the resident's expectations for you during morning work rounds	14	(1)
Arriving late for work rounds	15	(1)
Oral patient presentations are not brief and concise	15	(1)
Presenting patients in a disorganized fashion	16	(6)
Wasting the team's time while you take down a dressing	22	(1)
Correcting house staff on rounds	23	(1)
Not knowing your patient	24	(1)
Being afraid to say, ``I don't know''	24	(1)
Not working with the other students as a team	25	(1)
Not making a to-do list	26	(1)
Not paying close attention to what the residents say about your patient during work rounds	27	(1)
Orders and notes are not signed during work rounds	27	(1)
Not understanding your responsibilities during afternoon rounds	28	(2)
Preoperative Note
Not knowing how to write a preoperative note	30	(1)
Writing the preoperative note at the wrong time	31	(2)
Not having the structure or template of the preoperative note handy	33	(1)
Being unclear on what to write in the preoperative note	34	(3)
Not realizing that something important is missing prior to surgery	37	(3)
Not helping your intern write other patients' preoperative notes	40	(1)
Not receiving feedback on the quality of your preoperative notes	40	(2)
Brief Operative Note
Not knowing how to write a brief operative note	42	(1)
Not having the template of the operative note handy	43	(1)
Not knowing what to write in the operative note	44	(2)
Not knowing how to describe operative findings	46	(1)
Not knowing what to write under ``complications''	46	(1)
Not writing the postoperative orders	46	(1)
Not having a mnemonic for postoperative order writing	47	(1)
Not knowing how to write the postoperative orders	48	(5)
Not paying close attention as the end of the case nears	53	(1)
Postoperative Note
Not writing the postoperative note	54	(1)
Not having a template for the postoperative note	55	(1)
Not knowing what to write in the postoperative note	56	(3)
Not looking at the wound dressing at the post-operative check	59	(1)
Not paying attention to postoperative level of consciousness in an extubated patient	60	(1)
Answering questions that should be left to the resident or attending surgeon	60	(1)
Failing to check the lab test/EKG results (if they are done) as soon as they are back in the PACU	61	(3)
Daily Progress Note
Using an improper format	64	(4)
Note is too long	68	(1)
Not finishing the note in the morning	68	(1)
Incorrectly numbering the postoperative day #	69	(1)
Not including the patient's medication list	69	(1)
Writing an incorrect plan	70	(1)
Not adding information as an addendum	71	(1)
Scribbling out errors	72	(1)
Making premature diagnoses	72	(1)
Not writing the procedure note	73	(2)
Operating Room
Not attending the operating room orientation	75	(1)
Not paying close attention to what is said and done during the operating room orientation	76	(1)
Not being in the operating room every day	77	(1)
Finishing the rotation without seeing the core important cases	77	(1)
Not seeing trauma surgery	78	(1)
Not knowing what operations you will be seeing the next day	79	(1)
Not reading about the case the night before	80	(1)
Not preparing for your attending physician's questions appropriately	80	(2)
Not knowing what sources to read	82	(1)
Not reviewing the patient's chart before surgery	83	(1)
Not eating before surgery	84	(1)
Leaving valuables in the call room or in the OR locker room	84	(1)
Not going to the bathroom before surgery	85	(1)
Not taking your pager off before the case starts	85	(1)
Not wearing the proper surgical attire	85	(1)
Not covering your hair properly	86	(1)
Not wearing your mask appropriately	86	(1)
Not protecting your eyes	87	(1)
Not wearing appropriate footwear	87	(1)
Not following institutional policy regarding the wearing of scrub suits	88	(1)
Not introducing yourself to the operating room team	88	(1)
Not informing the surgical attending or senior resident of a mandatory conference	89	(1)
Scrubbing when your help is needed in the operating room	90	(1)
Not offering to put in the Foley catheter or prep the patient	91	(1)
Not asking for help during your first scrub	92	(1)
Not performing the surgical scrub properly	92	(2)
Not knowing what to do after you scrub	94	(1)
Not knowing where to stand at the OR table	95	(1)
Not doing your part to maintain the sterile field	95	(1)
Moving around too much	96	(1)
Not notifying the team if your surgical gloves become contaminated	97	(1)
Arguing with the scrub nurse or surgeon when they say you are contaminated	98	(1)
Not involving yourself in the case	99	(1)
Being discouraged if the surgeon is giving you a hard time or ``pimping'' you	99	(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