Before You Start

  • Review common surgical conditions presenting to your unit (appendicitis, bowel obstruction, cholecystitis, hernias)
  • Revise consent principles — you will be asked to consent patients for procedures your consultant has listed
  • Familiarise yourself with your trust/hospital's DVT prophylaxis and antibiotics protocols
  • Know how to request imaging at your institution

Theatre Etiquette

  • Arrive before the patient and know the list — review each patient's notes and imaging the night before
  • Scrub in correctly: nails short, no jewellery, correct technique for surgical scrub
  • Gown and glove without contaminating yourself — practise before your first case
  • Never cross a sterile field. If in doubt, step back and ask.
  • In the scrub position: retract when asked; hold suction confidently; do not fidget or lean
  • Demonstrate interest — ask relevant questions between cases, not mid-procedure

On the Ward

  • Know your patients before the ward round — review obs, bloods, imaging and plan
  • Carry a list: patient name, bed, operation date, post-op day, current issues, jobs outstanding
  • Discharge planning starts on admission — know each patient's expected length of stay
  • Consent documentation: confirm the operating surgeon has discussed the procedure and complications; you document and obtain the signed form
  • Wound checks: check all surgical wounds on your daily round, document findings

Surgical Emergencies — Know These

  • Acute abdomen: systematic examination, relevant investigations, when to escalate
  • Post-operative haemorrhage: early recognition, immediate escalation
  • Anastomotic leak signs: rising CRP, fever, tachycardia, localised peritonism
  • Strangulated hernia: irreducible, no cough impulse, exquisitely tender — surgical emergency
  • Testicular torsion: time-critical — immediate urology/surgery referral, no delays for USS if clinically clear

Building a Surgical Portfolio

  • Log your operative experience in your e-portfolio (ISCP in UK, ACGME LogBook in USA, etc.) from day one
  • Even as a scrub assistant / retractor — it counts; document your role accurately
  • Ask for direct observation of a procedural skill in each rotation
  • Identify one audit or QI project per surgical rotation
  • Attend and present at the departmental M&M (morbidity and mortality) meeting if invited