PGY-2 General Surgery
General Days
Surgery days start at the discretion of your chief. They will sometimes tell you when and where, but sometimes not. A good rule of thumb was to be in the SICU with numbers ready to round by 7AM. Notes don’t have to be done to round.
As a G2 you are responsible for at least all the SICU patients. When they get transferred to the floor you can either keep following them or turn them over to the G1’s. Depending on how busy things are or how complicated the patient, you can do either. I recommend telling your G1’s about the patients, though, to avoid confusion. I also found that rounds went much smoother if I had seen all the patients, even if just in passing. Pop your head in, push on their belly, and look at their wounds. 2 mins each tops. That little bit of knowledge comes in quite handy throughout rounds.
Part of your job is to keep the team moving and get your chief out early (makes them happy). Mostly this involves organizing your interns, which may or may not be a big job depending on your interns. Along with that is acting as your G1’s mentor. Try to train them in good, and encourage them to contact you, not the chief, with questions. Everything will go smoother that way.
The list is kept on the computer in the resident’s lounge. Update often (and have your interns do the same, I like to put the med student in charge of making sure some things are up to date like meds, etc…) Make a copy every AM for your chief and your attending for rounding.
Clinic
Day and time dependent on which team you are on. Same as every clinic everywhere. In the surgery clinic area next to the medicine walk in clinic.
Call
Call rooms are in the area around the surgery lounge. Get the trauma pager from the off-going team at 7AM weekdays, 8AM weekends.
For STAB’s, try to be the first one there. Some chiefs like the G2 to get in there and try to run the STAB from the surgery side. Examine the patient, talk to the pit boss, etc…. Let your chief stand in the back and look cool with their cup of coffee or whatever.
You are also the burn resident over night on call. There is a burn G3 or G4 who will take the burn patients in the AM, but anyone who needs to be admitted over night or who asks for a consult (sometimes outside hospitals will call you for advice) will be directed to you. Rule of thumb is see the patient, call burn staff if you have major questions or your chief with minors, and generally admit till they see the patient in the morning. There are packets of burn admission orders in the burn unit, and the nurses are awesome. Call the attending, too, they seemed to be happy to answer questions.
Consults
You will be asked to see everything from cellulitis (“Please tell us there isn’t an abscess under there.”) to acute abdomens with dropping hemoglobin. A good rule of thumb is to tell your chief about every consult within an hour after receiving it. Often there is not a chance to see them all within an hour, as you will get 6 consults in 5 minutes from clinics on Monday. In this case it’s probably better to enlist the help of an intern. Then if you can see the patient, too, most of the hard work (paper work) is done.
Some attendings do not like it when you carry the consult form around with you. Just start one, and leave it in the chart no matter how unfinished. You can always say “will discuss with staff” as your plan so at least the consulting team knows you were there.
Some of the attendings will make you staff every consult with them (after the chief sees the patient too), and some let the chief handle them alone. Leave it up to them, but never contact the attending directly unless the chief tells you to.
Conference
Every Tuesday morning at 7am. They have M&M till 8AM, then a lecture till 9AM. Generally it is optional to attend the lecture, but often they are pertinent topics that can be helpful.
Cross-cover and Signing Out
You are responsible for the SICU patients, every patient on a monitor (variable by nursing staff) and most of the CV patients. Just remember that the SICU patients are also covered by the SICU team. Read Baker’s recommendations (Neurosurgery) on the SICU team. They are your saviors for the SI patients. Keep them happy.
For most of the CV patients you will get a sign-out from Sharon Wall. Remember that 30-60% of post-CV surgery patients will go into Afib at some point or another. The nurses will freak out, but your job is to make sure that the patient is rate-controlled, isn’t symptomatic, and that they are on amiodarone. Also, if they have another underlying reason to be in Afib like dehydration or electrolyte abnormality, treat that.
And finally…
Make sure you get the palm pilot information from one of the surgery residents or one of us who has done the rotation- it's a group of a couple hundred notes organized by topic that you can carry on the palm. I didn't realize what a great reference it could be until almost at the end of the rotation- but there is some great information to be used.