Inpatient/Outpatient US Clinical Experience in General Surgery in Los Angeles

Information about this clinical experience:

You will be under the supervision of a board-certified general surgeon who has been practicing for approximately 20 years. The preceptor went to medical school and completed residency training in general surgery in the Midwest before establishing a practice in California. While training, the doctor was named "Resident of the Year" and received recognition for the quality of research performed. The doctor has continued this level of excellence as a general surgeon in practice, and is well regarded among peers and colleagues. The doctor holds staff appointments at Fountain Valley Regional Medical Center, South Coast Global Medical Center, Anaheim Global Medical Center, and Chapman Global Medical Center. Below you will find details about the experience, how you can enhance your learning and make a great impression, and earn a strong letter of recommendation. 

Operating Room

Three days of the week, you will spend the entire day in the operating room seeing multiple cases. To make the most of these learning opportunities, find out the types of surgeries that will be performed before your scheduled OR day. For example, if a hernia repair is scheduled, read about the disease or condition. Learn about the etiology, symptoms and signs, lab testing, imaging, differential diagnosis, complications, and treatment. Review the pertinent anatomy. Your preparation in advance of the cases will enhance your learning, enable you to answer questions your attending may ask, and allow you to ask your own more informed questions.

Remember that proper operating room etiquette is vital for patient safety. Teamwork is just as important. Work on building strong relationships with OR personnel and the entire team, including the nurse, scrub techs, and anesthesia team. Be a team player and see where your help is needed before, during, and after the case. Don’t be afraid to ask if you can be of assistance in any way. After scrubbing in, you will have the opportunity to see cases up close. 

Your proactiveness in helping the team in these ways will surely get noticed. “The way students can ingratiate themselves into the team is to get involved,” says Dr. Kirstyn Brownson, an assistant professor in the Department of Surgery at University of Utah. “Rather than standing in the corner of the room and observing, help move the patient onto the OR table, help the anesthesiologist and the nurse. Get warm blankets for the patient when they go into a cold operating room. Doing this as a student demonstrates that you are part of the team.”

General Surgery Clinic

Your time in the clinic will help you understand how general surgery patients are evaluated and managed before and after surgery. Patient encounters for preoperative evaluations will inform you of how these evaluations are performed, informed consent is obtained, and questions are answered. Postoperative care follow-ups will give you insight into the recovery process. Key items to evaluate in these follow-ups include wound care (check for healing or signs of infection, removal of stiches and staples), medication management, vitals monitoring, pain assessment, and review of activity restrictions.

Qualities to Demonstrate During the Clinical Experience

In a study done to identify a consensus set of roles, responsibilities, and expectations for medical students completing surgery rotations, researchers ascertained key attributes of professionalism and behavior from interviews with program directors, clerkship directors, and core surgical faculty. These attributes include the following:

• Demonstrating teamwork during rotation

• Interacting professionally and showing respect towards all members of the care team

• Contributing to a culture of safety and improvement

• Having strong work ethic

• Being available and accountable

• Communicating well with patients and their families

• Being punctual and present

• Demonstrating cultural humility and respect to patients from diverse backgrounds

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision (please note that this experience remains within the regulations of California pertaining to the unlicensed practice of medicine):

• Taking patient histories under supervision.

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Writing or entering clinic progress notes under supervision.

• Researching the literature to answer clinical questions at the point of care.

• Educating patients under supervision.

• Observing a variety of surgeries in the operating room (rotators are permitted to scrub in).

• Delivering talks about important topics.

• Have opportunities to teach other team members.

The activities above will mostly take place in the outpatient setting. As a result of hospital policies, inpatient activities will be more observational. 

You may also have the opportunity to work on a research project. Interested rotators are encouraged to discuss this possibility with the preceptor early in the clinical experience. The availability of such opportunities is at the discretion of the preceptor.