Syed Nabeel Zafar, MD MPH Class of 2008 Originally published at the Association for Academic Surgery on March 27, 2017 ------------------------------ Congratulations! You have matched. For all of you that have just matched in a surgical residency program, my heartiest congratulations to you. Welcome to the field. You guys are absolutely going to love it. It’s a rocky road and there are some ups and downs but the journey is fun. I am putting together some advice to serve as a guide for what is to come in the upcoming months. Most of this is based on my own personal experiences, speaking to and observing new surgical interns for the past few years. Some of this I wish someone had told me when I had matched five years ago. Hopefully many of your answers will be answered. If you have more questions just send me an email and I’ll be happy to answer, or just post a comment below so everyone can benefit. Celebrate Definitely go and celebrate. You will remember your match day for the rest of your life. I still remember the relief that washed over me when I found out. You have worked hard and deserve this for sure. Go and have fun with friends and family. If you are a little bummed by where you matched, you will get over that soon enough. Go out and enjoy. Relax a bit. Give and receive nice big hugs. Once you are done with all the Facebook-ing, Instagram-ing, Snapchat-ing, and tweeting, come back and read the rest. Spend time with family You are going to embark on a long journey with intermittent access to family. Make the most of the few months you have now. Spend time with your loved ones – get to know them more. We spend most of medical school stressing for this very event, and we often miss important occasions – birthdays, anniversaries, just helping with plain old house work. Now it’s done! No need to stress anymore; this is great opportunity to spend some quality time with your family, especially if you will be moving across states and countries. Thank your mentors Be certain to send out notes of appreciation to all the people who helped you along your way. There is never a solo achievement. Your mentors care about you and would like to know where you matched and how you feel about it. Please send them a nice note of gratitude – the earlier the better. And yes, it is perfectly ok to email the PD and the faculty at the program where you matched with a nice note of excitement. Getting ready for your intern year Now the meat of the matter…what to expect in the next three months and how best to prepare for your internship. 1. Paperwork……..aargggh! You will begin receiving ‘bundles’ of paperwork to fill out. If you thought there was a lot of paperwork in medical school, this is going to be much worse. Take a deep breath. Then organize yourself and sit down and do it. There will be forms to fill out for GME, parking, ID badge, IT access, state training licenses, employee health, etc., and there will be online modules to complete (HIPPA, documentation, etc). There is always enough time to do this, but please fill these out in time. Your program coordinator is your biggest ally. She/he will get you through residency and help you at every corner. DO NOT make an enemy out of her/him. The number one thing you can do to keep your coordinator happy is to complete all the paperwork in time. There will be a never-ending stream of paperwork from now until …well until you retire I guess. Learn to do it in a timely manner. It just makes everyone happy and helps things run smoothly. If you have to apply for a visa: J1’s – you’ll need your contract and statement of need asap to submit to ECFMG and get the process started. All the instructions are online. H1Bs – start this process as soon as you can. H1 visas take longer to process. If premium processing is still available, look in to paying for that. The bottom line is to be proactive, do not wait for GME and programs to tell you what you need to do . Work together to ensure things occur on time. 2. Orientation Closer to your start date you will be oriented formally to the hospital and to the department. These will be an intensive few days. Your coordinator or the GME office will inform you of the dates for the orientation. Try not to miss it or be late to it – if you do it just delays your start date and annoys everyone who makes the schedules. You may have been to the hospital and know the system well, but GME still has to check-off a number of items before you start, so orientation is pretty much mandatory. If you are already a prelim resident somewhere, talk to your program to be able to leave a week or so early for orientation. Keep your current PD informed of important dates. If you are not certified in ACLS and BLS you will be required to do these courses, either as part of the orientation or before. Beware! The ACLS online modules are looooooong. Keep a couple of days in hand for that. You are generally required to complete and pass the online modules before the practical onsite sessions. You will either be directed to employee health or be asked to submit a complete history and physical with immunization records. This usually happens at orientation or week or so before. Have your records handy. 3. Reading Often you feel like you have forgotten all of surgery. Obviously that’s not the case, but you still have to revisit it to awaken your memories. Do not show up to work not knowing things you are expected to know. At minimum you are expected to know what comes in the surgery shelf. My favorite piece of advice, when asked what to read at this stage is to go through Surgical Recall. You really can chose any review book but Surgical Recall is easy to read, has all the pimp questions, but also has practical stuff – names of instruments and drains, different knots, etc. When you start your surgery internship, you start running. There is not much of an ease-in period. Also at this stage, you can really stand out with your core knowledge. Many programs will subscribe you to FoS modules. ‘Fundamentals of Surgery’, these are roughly 110 short online modules that go through the basics of surgery and taking care of a patient on the floor. Fluid/electrolyte balance, pain management, NG trouble shooting, etc. It really is a good resource to get you prepared for what is to come. (You can read more about it here ACS Fundamentals of Surgery Curriculum ). The important thing is, don’t freak out close to your start date. You know your stuff, you just have to revise a bit. 4. Books to buy I would hold off on buying any books at this time (resist the temptation). You will all get access to SCORE. If you don’t already know- this is an ever-expanding surgical online resource with books, questions, surgical videos, etc. Much of what you need will be there. Secondly, you will have an educational allowance to buy books etc – use that to buy the books you need. Also, the program might have discounts, etc. Once you start, your senior residents will help you buy the right books. If you really want to invest more time in reading right now, read your medical student surgery text book completely (not Pestana notes- a text book). Then brush up on anatomy. 5. Practicing skills Surgery, unlike medicine, requires you to do both – read and practice skills. So you have to do both. You have been interested in surgery and thus you are expected to have some basic skills, such as suturing and tying knots. You are not taught these in the OR; you practice at home and polish yourself in the OR. You may get some instruction on them in sim lab etc, but almost all of the basic practice education is on your own time and at home. Don’t embarrass yourself by showing up not to tie a knot. At many programs you might have an intern boot camp or similar session during orientation, where you will be expected to perform some tasks. When a surgical intern comes in not being able to tie a knot we don’t say much, we teach them but then talk about them later and someone invariably asks “What medical school are they from again?” Also, if you are in the OR, the more you are able to do, the more you will get to do. Sorry for the lecture but every year there is someone who really makes me wonder about their interest in surgery. So here is how to do it. Everything is on YouTube. Find a video, play it on slow motion and practice in front of it. Once you have the hang of it – practice in your free time without looking, while watching TV or running, lounging, etc. In the beginning it is best to practice with something thick like shoe laces – to make sure your knots are square. Seek help – if you know a resident, friend, or someone who can make sure you are doing it right, ask them. When you start practicing with actual suture material, try to wear gloves and practice as well. It is very common for a resident to be great when practicing, but cannot do it in the OR. Gloves make a difference. Materials – I used the sim-vivo practice kits (sim-vivo.com ). You can get pretty decent supplies for $50-70, (definitely worth the investment). There are also some videos on the website that teach these skills. These are the skills you should try to master first – double handed tie, single handed tie. Simple interrupted sutures, horizontal and vertical matrix sutures, running sutures, and subcuticular sutures. Laparoscopic and endoscopic skills – you will have to wait to use the sim lab to practice these skills. I have not been able to find a nice cheap take home box trainer online. If you do know of any, please post it. ABSITE warning For those who do not already know this, every residency program has an in-service exam during the course of the year. The surgery course is called the ABSITE (American Board of Surgery In Service Training Exam). This one is important. Do not let your friends in other specialties tell you it is not important. The scores do matter. I have applied for two separate fellowships with two distinct application systems and both asked for my ABSITE score for each year. The ABSITE is offered annually at the end of January, so you have enough time to prepare for it. You are graded against your level of residents (PGY1s are scored against other PGY1s across the country). Housing and Buying Essentials As for housing, if you are not familiar with the city you are moving to, ask your coordinator to put you in touch with some of the residents and ask for their advice on the matter. Think about your rent and your commute, and the level of noise. My essential to buy list would include Black out curtains. A comfortable mattress, pillow etc (skimp money elsewhere if you have to) Comfortable work shoes. For the hospital- Not much to buy here – Stethoscope (cheap one will do – we are not medicine), trauma shears (buy a bunch -these tend to walk off on you), A small notebook (to log cases), Black pens etc. You can carry Maxwell with you for the first month or so if you need it. Seek Mentors This is probably the #1 most important thing you can do as a resident. Seek and find good mentors. Finding mentors is an active process. You should have faculty mentors and resident mentors (someone in PGY2 or 3 year and someone in the PGY 4 or 5 years). Having multiple and good mentors will almost guarantee you success. There is much written about how to find a good mentor, but if you have questions about it, please feel free to email me. It does not have to be a formal process; you identify senior residents you collaborate well with and frequently ask them questions about faculty, rotations, study material, etc. A good intern Read this article entitled “101 tips for the Surgical Internship”: General Surgery News In general, a good intern is reliable and hardworking, someone a senior resident can trust for accurate information, can rely on to get things done, and finally someone who studies and is prepared for cases. Attitude is the most important – respect your seniors, hunger to learn, and be friendly and nice. A great resident is also someone who helps out his or her colleagues, and there is an abundance of painful work to be done. If you can help others with that work, you’ll be popular very fast. Other advice Get step 3 done early. A good time to do it is either in the first few months of starting or in the second half of the year, after the ABSITE. (remember that you just have to pass – the score is of absolutely no value) Enjoy the journey. It really is a lot of fun as you experience yourself growing and learning and see faculty trusting you more and more. You really see yourself improving and it helps you forget all the not-so-great parts of training. Register and use the NCCN guidelines for cancer work up and treatment. It can be confusing at first, but the more you look at it the more comfortable you get with it. Use apps! They are a quick and easy ways to learn and read every day. You definitely need to have a pharma app on your phone. Most residents use Micromedex or Epocrates Join the Association for Academic Surgery if you have not already. It is a great society and is all about medical students, residents, fellows, and junior faculty. The abstract submission takes place in early August (they have a very high acceptance rate) and the Academic Surgical Congress is in early February after ABSITE. There are lots of inspiring talks at the Congress and great networking opportunities. You should also join the American College of Surgeons. Avoid delayed gratification – I really wish someone had introduced me to this concept before. Had I known, my approach to the first few years of residency would have been different. Burned Out? How Doctors Recover Their Spark A Career in Surgical Oncology: Finding Meaning, Balance, and Personal Satisfaction I hope this helps you better prepare for the exciting year ahead. If you feel overwhelmed, don’t worry. You will do great. You are about to begin what you’ve been waiting for a long time. If you have reached this point you are already a star and well equipped to handle all of the pebbles on your road. And remember, you are never alone! You have a bunch of co-interns and then you have a whole team of residents who have “been there” and “done that” They understand what you are going through, so if you’re ever in trouble, reach out to them and they will help you. Many, many congratulations again and good luck on your career as a surgeon!