Clerkship

Welcome to general surgery! The goal of clerkship in general surgery is to provide an overview of the many different types of surgical care we provide to our patients. You will be assigned to a team and it is expected that you will be fully integrated into the daily patient care activities whether it be on rounds, in the clinic or in the O.R.

You will see a breadth of surgical problems, with exposure to general surgical issues and specialty surgical issues. Your experience will be enhanced by on-call shifts with the other housestaff at which time you will be involved with the care of emergency and critically ill patients. We will get you to see the patients first so that you can take a history and physical and come up with a diagnosis and management plan. This is an excellent opportunity to see patients from their initial presentationthroughout their entire hospital stay.

You will quickly come to appreciate that surgeons are not mere technicians. Much of the art of surgery lies in the evaluation of the patient's presenting concern within the context of his or her overall physiologic status. The abilities to determine what (if any) operation is appropriate and to anticipate potential problems are as important as operative expertise. A physician-patient relationship must be forged, often in the acute setting, which allows patients to submit to painful procedures to their benefit. Managing the anxiety and pain concomitant with operative intervention is an important part of the care we provide.

Although the pace and organized chaos may make you feel overwhelmed, rest assured that you are an integral member of the team and the residents will rely on you to help manage busy surgical services.We work as a team and you may not think that you have a role, but you do! On morning rounds you can help by getting the charts ready and organized, reading out the vitals and new developments from the charts; this will help immensely and speed up rounds. Also, this will get you involved with learning about the patients. During the course of the day we may ask you to go and help us arrange tests in radiology or otherwise. This too helps the team function.

A good habit to get into is to check the bloodwork daily in the afternoon. When you do this write it down on a piece of paper (or use the attached template see below). If you do this before the PGY-1 does it andgive it to them they will love it! This will free them up to do the menial tasks that we would neverdream of asking you to do.

The most important part of the rotation, however, is being in the OR! You get to see what makes surgery different from every other thing inmedicine. You will learn to tie knots and we will get you involved in the case.

It is important to take initiative during the rotation and seek out any learning opportunity you wish. Try to read around the cases you see and ask your team questions. Start by reading the Toronto Notes. The other really good book I tell all clerks to get is called "Surgical Recall". It is a yellow andgreen book available at the U of T Bookstore. It is really good and easy to read. Don't buy the Advanced Recall - just buy the basic one. And finally, if you are super keen and know you are going to be asurgeon no matter what, buy Surgical Management and Treament by Lawrence Way (a red paperback book).