The unexpected challenges, continuous stress, and simultaneous demands of surgical residency make even the most mentally strong and physically fit individuals question their abilities to meet the highly sought standards of a top percentile surgical resident. How does one succeed in their first year of residency? The following information is a culmination of personal experience, advice from senior leadership, and shared wisdom those within my surgical program learned through trial and tribulation.
"Successful people form habits that feed their success, instead of habits that feed their failure.”
Create good habits in the beginning, as they will serve you well down the road. For each patient, pull up their imaging and go through the scans yourself. When reading patient charts in anticipation for the next day's cases, go through the H&P, the path reports, the radiology reports, and when time permits, seek your senior’s input on the surgical plan. Learn to ask questions early on as it will allow you to develop your own clinical algorithms based upon the texts you read and the clinical experience you obtain.
When on-call, a few pointers include “twilight rounds,” maintaining an open line of communication with nursing staff, and consistently checking patient charts. The concept of "twilight" rounds consists of making late night rounds on your patient census by yourself. This may not always be possible pending the course of the night. When you do get the opportunity to do twilight rounds, check each patient’s hemodynamic status, look for new lines or tubes, see if ventilation status or pressor support has changed, and briefly talk to nursing about any new events or possible concerns. When twilight rounding, check patient charts to verify the information is accurate. By being proactive, you develop a better sense of the clinical acuity of your patient census, and you can reduce the number of unnecessary pages.
Engage yourself early on in scholarly activity. Podium presentations, poster presentations, and conferences can be a great reward for your efforts toward completing scholarly activity. Attending conferences is a fantastic way to network with leaders in your future specialty of interest. Also, learning about how to conduct research can make you a better critical thinker, inspiring you to further investigate the current literature in your respective field, and simultaneously allowing you to build your CV.
One last habit to develop early on is your teaching style. Teaching can be one of the most rewarding and fulfilling experiences of being a surgeon-in-training. As well as being a proficient surgeon, clinician, and academic, one must keep at the forefront of their multiple responsibilities the ability to be a proficient educator. Whether covering a small 15-minute talk on a particular surgical topic or assisting with suture lab, teaching medical students is a great avenue to continue to build upon your teaching and presenting skillsets. At the end of the day, you are in residency to be a surgeon, however, part of the responsibilities of being a surgeon include being an educator to the next surgeon-in-training.
"Study while others are sleeping; work while others are loafing; prepare while others are playing; and dream while others are wishing."
Start your preparation for the American Board of Surgery In Training Exam (ABSITE) early in the academic year. I personally started in October due to the fact that I tend to be a slower reader than most, therefore, I provide myself additional time for adequate preparation. Keep in mind there is a significant amount of material you have never seen before, and you won’t know the details of more senior level procedures, however, at least seeing the material and completing practice questions on such topics will allow you to develop a sense for what surgical factors to consider. The Surgical Counsel On Residency Education (SCORE) and TrueLearn® question banks tend to be the most utilized question banks for ABSITE preparation.
Take the additional time away from work to hone your craft. Suturing and knot tying are essential, and being able to do both quickly will allow you to do more in the OR. An extremely valuable online resource on suturing and knot tying essentials is the UCSF Surgical Skills Center Kinesthetic Curriculum. For a jump-start on developing your laparoscopic surgery abilities, I recommend the FLS Expanded Video Tutorial on YouTube. For general surgical knowledge, a few resources I found most helpful included: podcasts such as Behind The Knife or Audible Bleeding, textbooks such as Schwartz and Operative Techniques, online videos provided by SAGES or the ACS for a quick reference point, and Radiopedia for learning radiologic fundamentals.
"An ounce of prevention is worth a pound of cure."
A previously published study conducted by the American College of Surgeons demonstrated upward of 40% of surgeons experience burnout and 30% screened positive for depression. With the COVID-19 pandemic, those numbers have continued to rise with 62.8% of physicians experiencing at least one episode of burnout during the year 2021. Given the persistent rise in burnout rates, it only makes sense that surgical trainees learn early in their career how to block out personal time. What to do with that personal time is up to you, but I advise you to focus on both body and mind. Whatever hobbies bring you joy, continue to spend time doing so.
“Life is about accepting the challenges along the way, choosing to keep moving forward, and savoring the journey.”
For those who are fortunate to have a significant other or family support nearby, remember that your training is just as rough and possibly even tougher on those who travel the journey with you. A more recent article published by JAMA demonstrated that out of all medical specialties, surgeons had one of the highest divorce rates at 33% after 30 years with a relative risk of 1.7 when compared to internal medicine physicians. Maintaining a healthy work-life balance can be a daunting task to take on, especially given the long work hours, excessive studying, conferences, simulation labs, etc. Being a new surgical trainee who had their first child in September of his intern year, work-life balance was critical to continue a healthy marriage. Have a date night with your spouse, keep in touch with your inner circle, and try to separate home from work.
In closing, one last pearl I would like to include is that as an intern, you must develop the ability to triage and prioritize tasks. You will have multiple tasks to complete at any given time, however, you must determine which tasks are most crucial and which tasks deserve priority. Your success and your ability to gain trust in others is partially dependent upon your ability to identify when tasks require immediate action. Constantly self-evaluating task priority is a critical skill to keep patients alive, to allow you to meet deadlines, and to keep your own house in order.
What do you believe are the most helpful pieces of advice to future surgical trainees? Agree, disagree, or add points to this list in the comments.
Wayne B. Bauerle, MD is a General Surgery Resident at St. Luke’s University Health Network (SLUHN) in Bethlehem, Pennsylvania. He completed his Postdoctoral Research Fellowship at SLUHN, his Medical Degree training at the Medical University of South Carolina (MUSC), and completed his undergraduate training at Clemson University. Wayne is actively involved in research and surgical education. Wayne is also an aspiring golfer, fitness nut, and an avid outdoorsman. He is a husband, father, an older brother to two siblings, and a proud cat owner
Illustration by Jennifer Bogartz and April Brust