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1/
Finished my
case as an attending!
Going from a trainee to an attending has been a steep learning curve to say the least.
Challenges change on a daily basis but definitely keep it interesting, glad I chose the right field for me!
Brief thread of what I have learned so far
Finished my
case as an attending!Going from a trainee to an attending has been a steep learning curve to say the least.
Challenges change on a daily basis but definitely keep it interesting, glad I chose the right field for me!
Brief thread of what I have learned so far
2/
Prepare on cases the night before, look at scans, notes, videos of the procedure.
Have an idea of what you would do incase something isn't going as planned eg. Ask for help, add another trocar, different instrument etc...
Prepare on cases the night before, look at scans, notes, videos of the procedure.
Have an idea of what you would do incase something isn't going as planned eg. Ask for help, add another trocar, different instrument etc...
3/
The initial goal should be to complete the procedure!
How fast & how cost efficient you are is not important at this stage.
Remember you want to have good outcomes starting off (1st impression really matters).
The initial goal should be to complete the procedure!
How fast & how cost efficient you are is not important at this stage.
Remember you want to have good outcomes starting off (1st impression really matters).
4/
For elective cases, chose the right patients initially, again your goal is to have good outcomes and not be the person who takes on anything/everything from the word getgo...
For elective cases, chose the right patients initially, again your goal is to have good outcomes and not be the person who takes on anything/everything from the word getgo...
5/
Do not take a patient to the OR without proper workup!
Utilize your colleagues to optimize the patients comorbid status.
Do not take a patient to the OR without proper workup!
Utilize your colleagues to optimize the patients comorbid status.
6/
Old adage, but the patient does indeed look at the incisions and mention it in the office later on
, so try to make it look as pretty as possible.
Old adage, but the patient does indeed look at the incisions and mention it in the office later on
, so try to make it look as pretty as possible.
7/
After any case, always do these:
Document brief op note
Talk to the family member
Get something to eat/drink
If the case is taking longer than usual, update the family members! Trust me on this, makes it easier to talk to them once done with the case.
After any case, always do these:
Document brief op note
Talk to the family member
Get something to eat/drink
If the case is taking longer than usual, update the family members! Trust me on this, makes it easier to talk to them once done with the case.
8/
Do not do elective cases late in the evening when there is a skeleton hospital staff and partners not available to help out.
You don't want to be in this position early on in your career.
Do not do elective cases late in the evening when there is a skeleton hospital staff and partners not available to help out.
You don't want to be in this position early on in your career.
9/
This might be obvious but call for help when in a difficult case. It's always refreshing to have another set of eyes/hands helping out. Asking for help is a sign of good judgement and not a weakness.
You would rather get help vs muck around for a couple of hours and cause harm
This might be obvious but call for help when in a difficult case. It's always refreshing to have another set of eyes/hands helping out. Asking for help is a sign of good judgement and not a weakness.
You would rather get help vs muck around for a couple of hours and cause harm
10/
Work with your hospital staff to streamline your instruments, equipments and anything special you need in the OR.
Otherwise it gets really annoying when you are asked the same questions over and over again, specially when you need to focus on a case.
Work with your hospital staff to streamline your instruments, equipments and anything special you need in the OR.
Otherwise it gets really annoying when you are asked the same questions over and over again, specially when you need to focus on a case.
11/
Surgery is a team effort. You are one part of the team. Treat everyone as a team member and you won't go wrong.
Do not bring "I am the surgeon" attitude to the hospital.
You might not realize it but people will go out of their way to help you out if you are nice to them.
Surgery is a team effort. You are one part of the team. Treat everyone as a team member and you won't go wrong.
Do not bring "I am the surgeon" attitude to the hospital.
You might not realize it but people will go out of their way to help you out if you are nice to them.
12/
Not a bad idea to get coffee/small meals with your OR team in between cases. You want them to see you outside the OR when things are not stressed and you don't need to have your focus on the patient.
Not a bad idea to get coffee/small meals with your OR team in between cases. You want them to see you outside the OR when things are not stressed and you don't need to have your focus on the patient.
13/
For Clinic days, look @ list the day prior to see what pathology you will see, rectify any issues with the start/end time, add/remove any patients according to the follow ups or wrong referrals.
Goal is to make clinic go as smooth as possible & it starts the day prior
For Clinic days, look @ list the day prior to see what pathology you will see, rectify any issues with the start/end time, add/remove any patients according to the follow ups or wrong referrals.
Goal is to make clinic go as smooth as possible & it starts the day prior
14/
Get EMR savvy and pre-populate your notes so that you are not writing it all out.
Utilize dot phrases to your advantage.
Your goal should be to complete all notes before you leave clinic if possible.
Avoid taking working on notes home!!!
Get EMR savvy and pre-populate your notes so that you are not writing it all out.
Utilize dot phrases to your advantage.
Your goal should be to complete all notes before you leave clinic if possible.
Avoid taking working on notes home!!!
15/
Goes without saying, if anyone asks you for advice, ITS A CONSULT, even if they don't explicitly mention it.
If you say something, document it.
Although you can't fix everything, it's a good habit to go see a consult before saying "NTD" or another field referral.
Goes without saying, if anyone asks you for advice, ITS A CONSULT, even if they don't explicitly mention it.
If you say something, document it.
Although you can't fix everything, it's a good habit to go see a consult before saying "NTD" or another field referral.
16/
Sometimes being attending will feel like being an intern, meaning nothing goes right!!!
Those are days to forget and move on. Some days are just not your days no matter what you do.
#forgetandmoveon
Sometimes being attending will feel like being an intern, meaning nothing goes right!!!
Those are days to forget and move on. Some days are just not your days no matter what you do.
#forgetandmoveon
17/
Dealing with a complication including death is extremely difficult. Just remember to take an informed consent going over them with the patient/family before you take to the OR.
Unfortunately, this is part & parcel of our field...just put your best effort.
Dealing with a complication including death is extremely difficult. Just remember to take an informed consent going over them with the patient/family before you take to the OR.
Unfortunately, this is part & parcel of our field...just put your best effort.
18/
Always good to talk to a mentor or a colleague after a complication/death.
You need to sometimes hear it from them you did everything possible to prevent it.
Blaming oneself is going to happen and you need to keep telling yourself you did your best.
Always good to talk to a mentor or a colleague after a complication/death.
You need to sometimes hear it from them you did everything possible to prevent it.
Blaming oneself is going to happen and you need to keep telling yourself you did your best.
19/
When there is a complication, although difficult, don't shy away from it, instead address it before it comes something worse.
Example, purulent discharge from a wound, don't ask patient to continue dressing changes, you do something about it scan/remove staples, pack etc
When there is a complication, although difficult, don't shy away from it, instead address it before it comes something worse.
Example, purulent discharge from a wound, don't ask patient to continue dressing changes, you do something about it scan/remove staples, pack etc
20/
If your oncall and your partners patient needs to go to the OR, inform them of your plan. This will do a couple of things:
Not catch them blindsided
May make them come in and help out
You may find out info you wouldn't have know (such as altered anatomy)
Makes you trustworthy
If your oncall and your partners patient needs to go to the OR, inform them of your plan. This will do a couple of things:
Not catch them blindsided
May make them come in and help out
You may find out info you wouldn't have know (such as altered anatomy)
Makes you trustworthy
21/
As an attending, you will be referred patients with issues you might not be comfortable with. Do what is the most safest thing in this situation. This could include going to the OR with a partner or referring the patient to another surgeon.
Do not go to the OR alone!!!
As an attending, you will be referred patients with issues you might not be comfortable with. Do what is the most safest thing in this situation. This could include going to the OR with a partner or referring the patient to another surgeon.
Do not go to the OR alone!!!
22/
Being a surgeon is physically demanding and can be draining. You need to ensure you are maintaining a work life balance.
Off days means you are off and not answering to patient related issues/doing notes etc.
Important to focus on this early on to avoid Surgeon Burnout!!!
Being a surgeon is physically demanding and can be draining. You need to ensure you are maintaining a work life balance.
Off days means you are off and not answering to patient related issues/doing notes etc.
Important to focus on this early on to avoid Surgeon Burnout!!!
23/
Hopefully you found this thread helpful. Congratulations on your journey, and wishing you success with your endeavors.
In the end, when faced with a difficult scenario I would just say to practice the KISS rule:
Keep
It
Simple
Silly
To the next (insert number) of cases...
Hopefully you found this thread helpful. Congratulations on your journey, and wishing you success with your endeavors.
In the end, when faced with a difficult scenario I would just say to practice the KISS rule:
Keep
It
Simple
Silly
To the next (insert number) of cases...
