Dr. Samuel Azeze and Dr. Shelby Wood also contributed to this post.
The night prior to starting my surgery rotation, I couldn’t tell whether I was filled with anxiety or excitement, but either way I wasn’t getting any sleep that night. So many colleagues and faculty brought up rants and raves about the surgery rotation—always with mixed reviews—and that resulted in even more confusion. I didn’t know what to think, how to approach the rotation, or how to succeed.
Two years after completing my surgery clerkship and becoming a resident, I recall the factors that led to my success during surgery rotation, along with some lifelong lessons I learned during those three months.
Here’s what you need to succeed during one of the most challenging parts of third year.
Studying for shelf exams and Step 2? We’ve got you covered! Check out Blueprint’s combined Step 2 & Shelf Exams Qbank with 5,500+ questions with detailed explanations, analytics, and more!
How to Excel on Your Surgery Rotation
1. Be prepared.
Have your surgery rotation review resources ready to go before your first day. Keep in mind, the material you need to learn for the surgery shelf exam may be different from what’s presented during your surgery rotation.
While certainly not a requirement, many students find it helpful to purchase a review book beforehand. This ensures they’re exposed to the material that will likely be tested on the surgery shelf exam and Step 2 CK.
Resource recommendations for the surgery rotation include “Case Files” and “Pestana’s Notes.” Make sure you have access to a question bank—such as Blueprint Prep and/or another option from our top shelf resource list—as you’ll need to complete all of the medicine and surgery questions before the shelf examination.
It’s also a good idea to complete at least the GI and cardiovascular internal medicine questions before your surgery shelf as well, especially if you haven’t had your medicine rotation yet, as this material often shows up on the exam.
Last but not least, a copy of “Surgical Recall” will help you get those pimp questions in the OR correct so that you look like a superstar.
Why should you prepare and how can it help?
Preparing your resources before starting your surgery rotation provides a strong foundation for success, both in clinical performance and on exams.
Here’s why:
Efficient Learning
Surgery rotations can be hectic, with early mornings, long hours in the OR, and demanding clinical responsibilities. Having your resources ready and tabbed minimizes wasted time searching for study materials and ensures you can use downtime productively, such as reviewing concepts between cases or during lunch breaks.
For example, having books like ”Surgical Recall” or ”Pestana’s Surgery Notes” earmarked enables you to quickly review high-yield surgical cases. They’re also great references for pimping questions commonly asked by attendings in the OR, especially the GI and cardiovascular sections.
Targeted Study for Exams
The surgery shelf exam emphasizes clinical management, pathophysiology, and procedural knowledge, which may not always align with what you observe in your day-to-day rotation. A review book tailored for the shelf ensures you’re covering exam-relevant material that might not be emphasized on the wards or in the OR.
For example, if your day-to-day surgery rotation primarily focuses on trauma cases but the exam includes common surgical conditions like hernias, appendicitis, and postoperative complications, a resource like those mentioned above can help bridge that gap.
Confidence in the Clinical Setting
Familiarity with key surgical topics before your day starts helps you feel more prepared when discussing cases, presenting patients, or answering questions in the OR or outpatient clinic.
Example:
Imagine your first day in the OR involves an appendectomy. Without preparation, you might not know the relevant anatomy, common complications, or how to anticipate questions from the surgeon. However, if you’ve reviewed, you’d already know the critical landmarks, common presentations, and key postoperative considerations to be aware of. When the attending asks about the blood supply to the appendix, you confidently answer. This not only impresses your team but also boosts your confidence for the rest of the rotation.
Feeling uneasy about being in the OR? We’ve got you covered with these guides:
😵💫 7 Tips to Help You Avoid Fainting in the OR
😷 Scrub Up: Tips for Your First Time in the OR
2. Be punctual & be present.
Never, ever, ever be late. This golden rule applies to all of your rotations, but it’s especially critical in surgery. The residents and attending physicians are restrained by a rigid operating room schedule. If you’re late, they’ll move on without you, and you’ll be left behind.
The way to avoid being late during your surgery rotation is to arrive at the hospital early and always offer to help, making yourself an integral part of morning rounds. This will get you noticed by residents and attendings as a medical student who is willing to work hard and cares about patients.
You should know your patients well (i.e. more than what’s expected of a resident, who often have more patients and less time). After rounds, pick up cases where you have the best chance of getting hands-on training. These cases are usually with the senior and chief residents. This is your best chance to be rewarded for your hard work during morning rounds.
Sign up for as many cases as you can and be present during your surgery rotation. If you don’t have a case, inform the residents that you have some free time and would love to help with their clinical duties. Make use of any downtime to attend cases in the operating room and seek out opportunities to practice skills such as suturing or wound care.
Surgery rotations are rigorous and demand discipline, professionalism, and initiative. Being punctual and present not only demonstrates your work ethic, but also opens up opportunities for meaningful learning and hands-on experience.
Here’s how:
You demonstrate professionalism.
Punctuality reflects your respect for the team, patients, and the strict surgical schedule. In surgery, timeliness is critical because operating rooms (ORs) adhere to precise schedules, and delays can disrupt patient care for the entire day.
It builds trust and rapport with the team.
Showing up early and being available to help demonstrate your commitment to patient care and the team. Residents and attendings take note of students who are reliable and willing to contribute. Over time, they’ll trust you with more responsibility and hands-on opportunities.
Example:
On your first day, you arrive at the hospital at 5:30 a.m. You check the EMR, review labs, and learn the histories of your three patients. On rounds, you impress the team by presenting confidently and anticipating the next steps in management. After rounds, you offer to help prep the first case, a laparoscopic appendectomy. By being present and proactive, the resident lets you hold the camera during the case, a rare opportunity for a medical student. Between cases, you practice suturing with the chief resident, who then trusts you to assist with skin closure on the next surgery.
By showing up early, staying engaged, and always looking for ways to contribute, you maximize your learning, earn the respect of your team, and gain invaluable hands-on experience that sets you apart during your surgery rotation.
3. Be assertive.
Always ask to see more, do more, and be more involved in patient management. Offer your patients exceptional care. This will not only delight your patients, it’ll be recognized by the residents and staff.
In addition to patient management, be assertive in your approach to preparing for Match by asking for a letter of recommendation (LOR) from a senior faculty member or program director. Make professional connections early on and maintain them by assisting in cases with faculty that you revere. For more about LORs, see my post about getting a perfect letter of recommendation.
Additionally, be proactive by making sure you complete your daily readings and designated question bank. There’s no shortcut to success, and learning is a self-directed process during surgery rotation when there’s no one telling you what tasks you need to get done each day. It’s up to you to plan time in your schedule for reading and completing practice questions with the goal of doing well on your shelf exam.
Being assertive and proactive on your surgery rotation is key to making the most of your experience. This doesn’t mean being overbearing; rather, it means demonstrating initiative and a desire to contribute.
Example:
During your surgery rotation you notice that one attending, Dr. Thompson, performs complex vascular surgeries. On a quieter day, you approach her and say, “Dr. Thompson, I’m really interested in learning about this angioplasty. Could I join you in your upcoming OR cases and assist wherever possible?” Dr. Thompson appreciates your interest and invites you to scrub in. During the procedure, you demonstrate your preparedness by identifying key anatomy and asking insightful questions about the approach. After the case, you ask, “Dr. Thompson, do you have further reading recommendations?”
This assertive and proactive attitude gains you hands-on experience, strengthens your relationship with your attending, and sets you up for a strong LOR. If you don’t ask for opportunities, you may miss out. Residents and attendings are busy, and they may assume you’re content observing if you don’t speak up.
4. Last but not least, be courteous.
Never treat a colleague, resident, or patient with anything but respect. This is especially important to remember during your surgery rotation, as you’ll meet a variety of personalities, some of whom you may not initially get along with.
What should you do if others are behaving badly? We have tips on how to handle unprofessionalism while on rotation.
You must remember that you’re on surgery rotation for only three months, but this is a career for everyone else working around you. Many of the surgical staff have countless years of experience in this setting.
You have a lot to learn from everyone there, from the neurosurgeon to the scrub tech. Never act as though you’re better than anyone else in the OR and keep your medical student ego in check. Offer your help in excess to everyone including scrub nurses, patients, etc. This won’t be overlooked by the staff, and you’ll be rewarded for your enthusiasm and utility.
Surgery rotations can be stressful, and tensions often run high. By maintaining a courteous and respectful attitude, you contribute to a healthier, more cohesive team dynamic. This will make residents, attendings, and staff more likely to involve you in learning opportunities.
Surgery is a team sport, requiring collaboration among surgeons, residents, scrub techs, nurses, and medical students. Your role is to learn, assist, and contribute where you can. Maintaining humility earns respect from your team. For example, if you’re assigned a smaller task, like holding retractors for an extended period, do it diligently without complaint. A senior resident will notice your work ethic and reward you with more responsibility over time.
By treating everyone in the OR with respect and professionalism, you earn the trust and support of the surgical staff. When the resident asks for someone to assist with suturing at the end of the case, the scrub tech might recommend you based on your earlier attitude and initiative.
Final Thoughts
Surgery rotation can be tough. But you can do it, and using these tips will help you stand out from the crowd. By being prepared, punctual and present, assertive, and courteous, you’ll be on your way to crushing your clerkship and your shelf examination.
Good luck on your surgery rotation! And when it comes time to take your shelf exam, check out our FREE quiz to make sure you’re on track 😎
