In Victoria the intern year consists of five 10-week rotations, with compulsory rotations of at least one surgical, medical and emergency terms. For those changing over to a surgical term, I thought I would share what makes a great surgical intern from the point of view of your registrars. I never cease to be amazed how worried some interns are to be starting their surgical term, so hopefully these tips can help reassure you that working on a surgical unit can be really rewarding, lots of fun and yes probably a bit busier than your medical terms, but don’t worry you will acclimatise quickly!

Organised Chaos and Efficiency

Surgical units are fast paced, with a high turnover of patient admissions and discharges.  There is no typical day in a surgical unit, but some general rules do apply.  Every day starts with a ward round of all admitted patients and any new ones that have come over night if your team were on call the day before. Theatre is divided into morning and afternoon operating lists each day of the week for elective (planned) operations, figure out which days of the week your unit operates and which sessions by asking the registrars for the week’s theatre list. There will also be ad hoc operations on the emergency theatre list for patients presenting to ED with acute surgical problems. Interns will typically admit the elective patients to the ward which means documenting their past medical history and charting medications.  Surgical units also have regular clinics on various days of the week to see new referrals for patients who may need an operation/further work up and to see the postoperative patients.  Interns typically attend the pre-admission clinic, where a patient’s overall health and fitness for their surgery is assessed, with outstanding investigations such as a cardiac echo are reviewed to ensure there are no medical problems preventing the surgery from going ahead. When your team is on call you may find you help your registrar see and admit new referrals too.   Then there is preparing for the regular multidisciplinary team meetings, audits, pathology and radiology meetings etc. 

I am sure you get what I mean by organised chaos now, preparation for the things you can be prepared for is essential because so much of the ‘typical’ surgical workday is unpredictable! Coming into your second intern rotation you likely feel more efficient than when you started internship, things such as preparing ward lists, writing ward round notes, discharge summaries, discharge scripts etc are becoming more familiar.  Then you step onto a surgical ward and you realise the pace of things is much quicker.  We know interns take time to adjust to this change of pace in a surgical unit, and so do the nursing staff, clinic staff, and theatre staff etc. Aim to prepare as much as possible in your down times so that when your day gets busy you are ready to get going!  Another challenge for some junior doctors is the sense of uncertainty on a surgical unit, every day is different (which is half the joy for surgical trainees) but for those junior doctors that prefer structure and planning it can be quite an adjustment.  

Intern Responsibilities

So many juniors ask me what the intern does on a surgical unit, so here’s a brief overview:

• Prepare ward lists each morning and afternoon (patient details, history, investigation results, operation details, complications etc.)
• Ward round: writing notes, checking medications, fluid balance, bowel actions etc.
• Keep a running list of jobs for each patient – write everything down!
• Participate in paper round and prioritisation/allocation of jobs. 
• Clarify plan for the day and who is doing what …which intern is on for theatre, clinic ward etc. and where  you can find the residents and registrars if you need. 
• Organise discharges and facilitate their follow up plans (imaging, bloods, clinic, meds)
• Discharge summaries – include salient findings from the operation report 
• Help your seniors to admit patients.
• Identify and escalate early any deteriorating patients to your team. 
• Follow up on morning jobs – images, bloods, read the consulting team plans. 
• Unit specific – may include surgical audits, weekly meeting preparation, theatre planning.

With so much to do each day you will learn with experience how to prioritise the important and time sensitive jobs that need to be done first, asking your seniors at paper round how time critical an investigation or review is will also help! 

The best characteristic of any intern is their eagerness to learn new things.  Seniors see enthusiasm and feel passion, we all love what we do and when we see that passion in our team members it is a joy to teach, learn and work together. Your unit will very quickly become your friends if you get involved in all facets of the surgical workday. 

Teamwork

The amazing thing about working in medicine is that you are never alone, it is a huge team effort to take care of sick patients and surgical units are no different. The nursing staff on surgical wards are specialised and often do further education in surgical subspecialities so they will be a wealth of knowledge! Equally the pharmacists are a godsend to junior doctors who are still trying to learn the ins and outs of prescribing medications.  Allied health allies will interpret what those mobility restrictions from the operation actually mean and advise you what care needs the patient will require on discharge.  Clinic nurses will let you know the ins and outs of how clinics run and what your responsibilities are.  Theatre nurses will teach you how to scrub.  The list is endless of people who make a surgical unit go round so always remember there is someone to ask for help every step of the way! 

I remember the content satisfaction at the end of each workday on my surgical rotations knowing that my hard work contributed to patients getting the care they needed and seeing them be discharged home after recovering from their operations was very fulfilling.  There is an immediate sense of achievement when you see a patient get better postoperatively which is one of the great things about being a surgical trainee.  You also realise fairly quickly that even though you might not be in the operating room very much as an intern, your patients wouldn’t get the care they need on the wards without the hard work and dedication of the interns – and your registrars would not be able to operate and attend clinics without your contribution either! You are a highly valued member of the team, even if you are not scrubbed every day. 

I encourage you to make the most of your surgical rotations!  Having a good baseline knowledge of surgical presentations, conditions and their management will serve you well in the long run regardless of what training pathway you think you want to pursue. Better yet, you may find ‘your people’ in your surgical rotations and want to join the surgical dream teams forever!