Try to get a good nights sleep before the exam. Specialty residents rotating on your service may not have to take the test, so arrange for them to take call the night before. Its a bit costly to travel and stay in a hotel not to mention the potential loss of vacation time to do this , but it may be worthwhile if studying by yourself fails.
Start out with the mindset that Im reading to become a competent general surgeon. You should plan on reading through at least two core general surgery textbooks in traditional bound or electronic format during the course of your residency. In the first two years of residency, it should be a core basic science textbook see bibliography in the Appendix ; during the last half of your training, the textbook should be one that deepens your foundation in surgery and.
Review the table of contents and set a reading schedule for yourself. Plan to finish each book by the end of the academic year. What you read will be reinforced by your rotations on different surgical services. This book does a good job of addressing the breadth of the ABSITE topics; however, there are some areas of inaccuracy where it relates to current standard of care.
The best thing to do is not rely on this review book as your only source of information. The major basic science textbooks e. Sabiston8 or Schwartz9 have question books that accompany the textbooks.
The questions usually per chapter are designed to be used after each chapter is read. You should be working on those all throughout the year. Some options are listed in the Appendix.
Review Courses see Appendix. The score report doesnt give the exact question verbatim, but it does highlight the key topic. December would be a good point to go over each of them line-by-line to make sure that you understand why you missed them. Its no secret that questions are repeated from year to year.
It is a book filled with one-line questions and answers on Remember, youre in training to become a competent general surgeon; anything you do to advance that process will help you do well on the ABSITE. Private hospital training programs will differ considerably from universities, and the hierarchy in single-hospital programs will be easier to decipher than in multi-institution programs.
In general, each department will have a Chair, Division Chiefs for the various surgical specialties, and a number of attendings whose roles will vary considerably from one place to another. The Chair The Chair of Surgery at a College of Medicine is the Big Dog, responsible for all academic, clinical, and research activities of the department. The Chair manages the faculty and support staff, and is responsible for the departmental budget.
In many institutions, the Chair of Surgery is also the Chief of Surgery at the major teaching hospital, but this is not always the case. The Chair is ultimately responsible for the quality of care, the spectrum of services offered, and may be responsible for the practice plan. The Chair reports directly to the Dean of the College of Medicine. The Chief of Surgery The Chief of Surgery oversees all the surgical activities at one hospital and is ultimately responsible for patient care that is delivered in the ORs, ambulatory surgical center, SICU, and surgical wards and clinics.
The Chief is responsible for compliance with accrediting bodies e. The Joint Commission11 and may be involved in institutional quality initiatives. The Chief of Surgery reports to the Hospital Director. Division Chiefs The Division or Service Chief has a more narrow focus, and is responsible for the clinical activities of attendings within that Division. The Division Chief may oversee activities at several affiliated hospitals. He or she is responsible for the educational activities within the division, and may be responsible for research activities within the division of an academic institution.
They oversee the rotation assignments and see that you have training in each subspecialty as required by the Board. The Program Director will assign an advisor to each resident to ensure that the resident receives timely feedback and advice on career decisions.
However, you are also free to ask any other attending to be your informal advisor or mentor. Above all else, the Program Director is a resident advocate and as such should make an effort to get to know each resident personally.
Your Program Director is the primary author of your residency summative evaluation and letter of recommendation. A Coordinator reports to the Program Director, and typically views him or herself as filling multiple roles, including counselor, advocate, den mother, social planner, cheerleader, arbitrator and data analyst.
Keep in mind that the Residency Coordinator is on your side and can be a tremendous resource for you. Do not feel intimidated or threatened by confiding in this person. Most Program Directors view the Coordinator as the programs most valuable resource. So treat the Coordinator respectfully at all times. House Staff Hierarchy The house staff hierarchy is determined by your training year. There are sometimes specific types of operative cases or procedures associated with each year i.
There are also specific tasks and rotations assigned by year. A house staff team is hierarchical, and you should pay attention to the chain of command when fulfilling your clinical duties. For example, if as an intern you consistently inform an attending of non-urgent patient problems but neglect to let the junior resident or Chief know, you will be persona non grata pretty quickly.
No one likes to be caught off guard. On the other hand, if an attending asks you to do something, clearly that task must assume some priority in your list of to-dos. Remember, trouble rolls downhill, and unnecessarily and consistently jumping the chain of command in a non-emergent situation is a good way to make it roll harder and faster.
A mentor also can be referred to as a sponsor, which is defined as one who assumes. The first criterion for a mentor is someone who is wise, which means not only knowing the facts, but also knowing what is true, right, and lasting. They have experience, common sense, and good judgment. This usually means someone senior to you in the surgical hierarchy. The relationship should be mutually beneficial, and evolve over time until you become a valuable colleague to the mentor.
Why You Need a Mentor Having a mentor is absolutely essential for you to advance through the academic ranks. A mentor can serve many useful functions to make your professional life successful and progress easier. They can offer advice on everything from surgical techniques to solving a tricky clinical situation, to useful references. A mentor should help you to understand the hierarchy and chain of command in both your own program and the field of surgery.
You must learn whom to trust, and whom to avoid. Mentors can promote you by nominating you to speak at conferences, publish papers, and become involved in lab research or clinical trials. Mentors can give you thoughtful critiques on your clinical work and your writing.
A mentor will alert you to useful meetings and conferences, both for their political as well as their educational aspects. Mentors can ensure that you receive challenging assignments that will showcase your talents. It will enhance your reputation to be associated with and accepted by a good mentor. A good mentor will help you to stay focused and avoid over-committing your time to activities that will not enhance your career aspirations. A good mentor will also serve as a role model for you in terms of style, demeanor, and dealings with patients and others.
Simply having the mentors support can be a protective measure if you find yourself in a hostile environment. Contacts and networking are keys to success in the academic environment. Therefore you must actively seek out a mentor for yourself. Finding a Mentor In your lifetime you will almost certainly have more than one mentor, as your interests and priorities will change over time.
It is helpful to have at least one mentor who has a solid reputation within your own institution and is a more senior faculty member, but not necessarily a member within your department.
The ideal candidate should have strong contacts within the national surgical societies and may be actively involved in research. This is particularly important if you are planning for an academic career. It will probably take some time to identify someone and develop a working relationship. Keep in mind that you are not the only one who benefits from the association with your mentor; there is a strong synergism between good mentors and their protgs.
When you are successful, your mentors stature among his or her own colleagues is enhanced. Some of the most lauded surgeons are department chairs who have promoted their own faculty so well that they have also become department chairs.
Recognize that your mentoring needs are likely to change over the course of time. You may find it useful to build a pool of mentors maybe even in different institutions or disciplines to help with different aspects of your professional life as your career evolves. If your intent is to enter private practice, you should seek a mentor who is in that type of practice. It is easier to ask someone with whom you have some rapport to help you find a job, set up practice, and choose between solo, group, or HMO practice.
Another option to help evaluate job opportunities is to use the AWS Directory to find someone practicing in your area or the area to which you may wish to relocate. A large number of women in AWS are in private practice, and most are willing to offer advice to younger women coming up through the ranks. While the prospect of going solo may seem daunting, it is not nearly as difficult as it seems at first glance.
De Virgilio C et al. Predicting performance on the American Board of Surgery qualifying and certifying examinations: a multi institutional study. Arch Surg ; 9 : 6 4. Atluri P. Steven Fiser, Sabiston Textbook of Surgery.
Townsend, Beauchamp, Evers, Mattox. Hardcover 9. Principles of Surgery, 9th Edition. Seymour I. Schwartz, et al. McGraw Hill Text Blecha and Andrew Brown American Heart Association Mentoring Handbook. Second Edition, November Everyone does. Some will be little mistakes of no consequence; others may be life-compromising for a patient.
NEVER try to cover up mistakes you make. In these situations do the following: Get help. Tell the truth as you know it. State only facts. Do NOT offer excuses or try to blame someone else. Keep explanations under wraps unless specifically asked for them. Be careful what you say of others; it will reflect just as much on you. Accept responsibility when it lies with you. This is especially important when dealing with medical students and more junior residents. If you tell them to do something and problems ensue, accept responsibility.
If others dump on you when you were really not involved, take them aside and discuss it in private. Make it clear that this behavior is unacceptable. Ask for an explanation if you dont understand what you should have done differently and why.
However, you may need to wait until any hot tempers have cooled. However, no specialty is as acutely aware of the relationship between what we do or fail to do for a patient, and the outcome.
When a patient has a complication, it can be emotionally challenging for the operative surgeon. When a patient dies, it can be devastating. When this happens to your senior colleagues be supportive, and do not criticize or secondguess their decision-making. Some day it will happen to you. When it does happen to you, recognize that it is entirely normal to experience regret, guilt, sadness, anger, and a host of other negative emotions in response to a patients morbidity or mortality.
It is common to question your own abilities. It is okay to hole up in a bathroom and cry for a few minutes if you must. While it is permissible to shed a tear in private you must not, however, allow yourself to become psychologically paralyzed by a complication or poor outcome. If you feel this is happening, seek counsel from a more senior surgeon to help you put a situation in perspective. If you are more comfortable seeking help outside the department go to Employee Health for assistance.
A complication blamed on nature of disease is suspect and will not be as educational. Its not unlike a confessional and can actually be a cathartic experience. It is not the objective to punish or publicly humiliate you for an error. Most medical boards still require physicians to indicate whether or not they have a history of drug or alcohol abuse on licensure applications, and the medical profession, in general, still seems to be in a state of denial regarding the unusually high incidence of drug and alcohol abuse among physicians when compared to the general public.
NEVER consume alcohol when on call, even when taking call from home. Even if you have only one beer, you will smell just like you drank a case. Additionally, studies have shown that alcohol consumption degrades surgical skills among surgeons even well into the day following alcohol intake.
Most institutions have a confidential hotline to report colleagues who are impaired on duty. If you suspect a fellow resident has a substance abuse problem, you must bring this to the attention of the Program Director, who is obligated to treat your concern confidentially. A head in the sand approach is a disservice to the resident and, ultimately, to the public. If you believe you may be dependent upon drugs or alcohol, discuss this with your personal physician.
As terrifying as this may be, it will be much. The goal ultimately must be to identify and rehabilitate impaired physicians, not to punish them. You can also go directly to the Employee Assistance Office in your institution.
If you do need treatment, this will be treated as confidential and your Program Director is only entitled to know whether you are fit or unfit for practice, not the specific details of your diagnosis or treatment see Resident Rights at the end of this chapter. It may or may not be combined with sexual harassment. Examples of this would be if your department pays a woman less than a male physician for the same staff position or consistently chooses the male residents over the female residents for career advancement opportunities.
Under federal law it is illegal to discriminate in the workplace against a person based solely upon their race, color, religion, sex, national origin, age or disability. Harassment based upon these characteristics is illegal, and retaliation against an individual for filing a complaint of discrimination is prohibited. Protection extends to hiring and firing actions, compensation, assignment, and recruitment.
What Discrimination is NOT It is equally important for you to understand what does not constitute discrimination. When interviewing for a residency position or job, it is not permissible for the interviewer to inquire about your marital status or if you plan to have children. If you volunteer that you are planning to take an extended leave after each child, it should not be used as a criterion for refusal of employment, but extended absence from residency training could impact your timely promotion from one year of training to the next and your ability to graduate the program on time.
A blatant example is when an attending demands sexual favors and refusal will adversely affect your evaluations. A less obvious case would be where you are in the OR lounge and colleagues start telling dirty jokes or stories with the express intention of making you uncomfortable.
Title VII's3 broad prohibitions against sex discrimination specifically cover:. Sexual Harassment - This includes practices ranging from direct requests for sexual favors to workplace conditions that create a hostile environment for persons of either gender, including same sex harassment.
The "hostile environment" standard also applies to harassment on the basis of race, color, national origin, religion, age, and disability.
Pregnancy-Based Discrimination - Pregnancy, childbirth, and related medical conditions must be treated in the same way as other temporary illnesses or conditions. Note that as a woman you can not be refused a position because you may be exposed to agents that would affect the health of any baby you might carry.
This means that you can not be refused privileges for any case that might require fluoroscopy or use of a teratogenic agent though you should assess the risks for yourself and take appropriate precautions. For Women: What Sexual Harassment is NOT Surgery is a predominantly male profession although this is slowly changing so you need to understand what is not harassment.
You may be exposed to off-color stories or jokes from time to time. If they are not directed at you, try to ignore them and change the topic. If you find such jokes demeaning, speak up and ask that such comments not be made in your presence. You can point out that it is inappropriate to tell such jokes in front of individuals who may not feel comfortable voicing their disapproval e. Try to do so without being antagonistic or confrontational. Be very clear about this, and do not give any double messages while trying to be tactful.
In some cases, an older man will call you dear, or pat you on the shoulder. This may seem paternalistic and demeaning, but it may be how he was raised to treat women; he may perceive his actions as being polite and respectful to your femininity, rather than offensive.
Dont confuse courtesy with chauvinism; nothing irritates a guy more than a woman who gets angry when he opens the door for her. In most cases this is not harassment. Additional information can be obtained in a separate pamphlet on sexual harassment, which is available from AWS.
Dealing with Discrimination or Sexual Harassment All that being said, how should you deal with a presumed case of sexual harassment or discrimination? First, after an incident has occurred, sit down, take a deep breath and try to look at the situation objectively.
Record the facts of what happened in as much detail as you can recall. Review the problem with an objective outsider. Decide if the episode really was one of discrimination or sexual harassment. It may be easier for you to blame your lack of promotion on bias rather than the fact that another resident actually did a better job. If you decide that this was indeed a case of discrimination or sexual harassment, you have several options: Familiarize yourself with the discrimination and sexual harassment policies at your institution.
Document all incidents at the time they occur; a memorandum for record document is appropriate. Note the presence of witnesses. Use discretion when discussing the incident or behavior with colleagues. Use your personal e-mail account to communicate sensitive information, as your supervisor has the right to access your hospital or institutional e-mail account. Make an appointment with your Program Director to discuss the incident.
If the problem is with the Program Director, talk this over with a trusted staff member or mentor and let him or her help you. Be prepared to listen.
There may be other perspectives that you have not considered. Be prepared to support yourself with documentation, such as statements from witnesses of specific events, or letters of recommendation from other coworkers including other residents or nurses. Prepare yourself to be disappointed. Many men and women you consider your friends are not willing to stick their necks out if they think it will be detrimental to their own careers.
Come to meetings with a copy of your CV and any additional materials that you feel would bolster your case, such as evaluations from other physicians on staff. Record all discussions after any meeting. If specific promises were made, document them as well as any other comments made that you thought were significant.
These notes may have legal importance if the matter proceeds as far as arbitration or court. If possible, consider having someone you trust in the room with you. If you feel your needs are not met within your department there are several options. Check the bylaws, rules and regulations of your institution. Generally each institution will have an Equal Opportunity Office with staff trained to offer advice. Your Human Resource Department will know how to contact the appropriate staff. Resident unions or the Residency Housestaff Office may also be supportive.
If the problem is not being handled appropriately and it interferes with your surgical education, reporting to the RRC may be appropriate. Remember that you may be jeopardizing your program and your training by such reporting, however, your complaint may prevent another resident from having to deal with the same problem in the future.
If you are considering leaving your program, you might try to obtain a position in a different training program prior to reporting to the RRC. Legal action should be a last resort, but is a real consideration if you have serious, documented, and legitimate complaints that are not adequately addressed by your program or institution.
If you are threatened or pursued outside the physical space of your institution, it is time to seek legal advice. Find an attorney who is familiar with employment law particularly as it relates to discrimination and harassment.
Merely the threat of legal action often will cause a problem to disappear, but dont cry wolf. If you initiate a lawsuit, be prepared to see it through to the end. Prepare for a backlash and for the broader consequences of your actions. If you antagonize too many politically powerful people with complaints or a lawsuit, you may find yourself winning the battle and losing the war.
Your best defense against the rumors and innuendoes that can accompany such problems is to state your case in the most objective way. If you find yourself on the other end of a discrimination or harassment complaint, you have the right to request documentation for any incidents that are being held against you and to respond to any complaints [see Resident Rights].
Do not accept a statement that a complaint was made, but I wont tell you by whom, to protect their privacy. This type of secrecy is not permissible if it affects your career. Some residents spend one or two years doing research during their residency and choose to have a child during that time.
Others choose to have a child during the clinical portion of their residency. A pregnant resident was a rarity in the past; this is no longer true. It is an undeniable fact that the years a woman is typically in surgical residency happen to coincide with her last years of peak fertility.
That said, it is incumbent upon a woman resident to assume some responsibility for family planning. Before planning a pregnancy, investigate your institutions maternity leave and childcare options. Most likely, vacation time will be used as part of your maternity leave, so learn the rules at your institution early in the process. The graduate medical education office should have information available on these topics.
It also may be helpful to discuss them with a respected attending or friend whom you can trust. It is no longer tolerated for women surgical residents to receive verbal abuse from colleagues or attendings for getting pregnant. If you do feel ridiculed or mistreated, you should speak with the Program Director immediately.
It is safe for pregnant women to continue to perform fluoroscopy and interventional procedures with proper shielding. Some institutions will require a pregnant woman to wear a radiation detection badge on her abdomen to ensure limited exposure to the fetus. Sharing Your News: Deciding when to share the news that one is expecting is a very personal decision. For some, waiting until the second trimester 13 weeks , when the risk of miscarriage is substantially reduced, is the best option.
Be sure to give your Program Director and colleagues ample time to prepare for your absence during maternity leave. The issue of call coverage while you are out can be tricky. With current work hour restrictions, it is likely not possible to offer to take extra call before or after your maternity leave.
There may be some other way to repay your fellow residents; for example, by offering to cover an unpopular clinic assignment. Wear good support hose to avoid varicose veins and help with leg edema. Maternity Leave: A nationwide policy for maternity leave for residents currently does not exist.
Each institution has its own policy on maternity leave, so become familiar with it. The AWS put forth a statement in that encouraged each surgical program to provide six weeks paid maternity leave for residents. The American Board of Surgery ABS published the following statement in the Booklet of Information, For documented medical problems or maternity leave, the ABS will accept 46 weeks of surgical training in one of the first three years, for a total of weeks during the first three years, and 46 weeks of training in one of the last two years, for a total of 94 weeks during the last two years.
If, for unforeseen reasons, you do not meet these criteria, you may have to repeat a year or a portion of a year to qualify to take your Boards. Board Exams: Surgical residents who miss an extended part of their training as a result of pregnancy or any other reason may not meet the requirements to sit the American Board of Surgery Exams at the end of residency. This is not a problem if only the normal six weeks of maternity leave are needed.
It would be reasonable to expect consideration similar to maternity leave. It is very important to have these discussions as early as possible in the process so that expectations are clear and plans can be made. Childcare: Begin researching childcare options early, even as soon as you find out you are pregnant; there are frequently waiting lists. Institutions may offer childcare services at the hospital, and some may subsidize the cost of childcare for residents.
Ask colleagues, attendings, and friends who have children about available options. Choose the best childcare that you can afford. Knowing that your child is safe and well-cared-for will bring security and peace of mind.
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Covering everything from set-up to troubleshooting and medical management, this book presents an integrated blueprint for choosing the right tests and customizing IOM procedures to the demands of each surgical challenge. Comprehensive in scope and filled with over helpful illustrations, tables, and neurophysiologic recordings to aid interpretative understanding, this expanded edition includes practical examples of monitoring and mapping and details the importance of an individualized approach to IOM.
A highly visual book, it continues to serve as a primary resource for physicians and technologists involved in monitoring to help reduce the operative risk of neurological damage in surgical patients. There are also disagreements on the diagnostic criteria for brain death, whether clinical alone or clinical plus ancillary tests.
Moreover, some scholars who were strong defenders of a brain-based standard of death are now favoring a circulatory-respiratory standard. The study of coma is extremely important because lesions of the brain are responsible for quality of life in patients or cause of death.
The main goal of Brain Death and Disorders of Consciousness is to provide a suitable scientific platform to discuss all topics related to human death and coma. Small Animal Pharmacology and Therapeutics, 2nd Edition helps you understand both the therapeutic uses of common pharmaceuticals and the pharmacology behind them, giving you all of the information you need to design and modify dosing regimens, identify factors that cause drugs to fail, and anticipate adverse drug reactions.
Comprehensive approach emphasizes the use of drugs for prevention as well as treatment. It focuses on two aspects: Ando's philosophically-based theoretical concepts, and his major themes which have been introduced in the previous sections. This chapter provides a general and coherent understanding of his work. The concluding chapter summarizes the crucial points from among Ando's visions, moving from origins and philosophical grounds through concepts, strategies and theories, to the unique solutions which he advances for problems of the age.
Thematically, Tadao Ando's works may be shown to reveal: Dialogue with Nature and Tradition cosmologies, culture ; Shintai and Space mutual independence and penetration ; and Geometry spatial compositions, minimalist form, material and texture. Among these three over riding themes, there are many interrelated sub-themes are also examined. Download PDF.
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