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Surgical Clerkship: Resources

July 2, 2017


Hey Beautiful Folks!


Thank you all for reading! I am so appreciative of the personal messages and texts that I have received so far regarding the blog.  Please let me know if there is anything specific that you want me to address about being pre-med, med school the wards and the like. :-)


GOOD NEWS on the HOME FRONT. I passed my first NBME Shelf!!! Wooohoooo! I'm not going to lie, I was literally waiting to write this post until I knew that I had passed the surgery shelf because if I didn't...I would've been like welp, you're on your own because clearly what I did didn't work. HOWEVER, that is not the case! :-)  I can say that I would do somethings differently which I will expound upon in a little bit.  Let's get started.


FOR: Day to Day on the Wards 


Surgical Recall, Lorne H. Blackbourne 


Pros: I have alluded to this book in the last two posts because in my opinion, this is the best book for day-day on the wards.  It goes through everything from knot tying, surgical instruments, surgical positioning in the OR, presenting on rounds, pre-op care, post-op care and then a substantial amount of high yield factoids about the anatomy, disease pathology and typical surgical "pimping" questions.  I kept this with me everyday and although the book is thick, it is easy reading so you can review the few pages about the disease pathology of your next surgery right before heading into the OR.


Cons: It is a "recall" book. It is primarily the high yield facts, so it does not go into significant detail and you can find yourself wanting more of the big picture to have it all really make sense.  Also it is thick. It can still fit into your white coat pocket but it will definitely weigh you down a bit.


The Textbook 


Essentials of General Surgery


This book is great for the big picture and bringing it all together.  Our school provides and recommends certain books to us for each core and this is the one that they gave us and I actually really liked it.


Pros: For a textbook, it is very readable.  It is not too dense but you really get the full picture from Anatomy to Pathology to medical management to surgical options to Post-Op Complications and care.  So, it really gives you everything without making you want to gauge your eyes out.


Cons: It is a textbook. And it's long.  I know that some preceptors recommend that you read the entire book during your surgical clerkship but that is an impossible task.  I would try to read the pertinent chapters depending on which surgical service I was on, but if you're on general that becomes difficult because you can see everything.  However, if I were to recommend chapters to read for general just based on the most common cases you see: Appendix, Small Bowel, Pancreas, Liver and Gall Bladder.


So if you need a textbook for the big picture, I recommend it but don't beat yourself up if you find yourself unable to get through a lot of it.

...what you have all really been waiting for...Shelf Resources 


Shelf Specific: Books 


Dr. Pestana's Surgery Notes 


Hands down this is the most important book of studying for your Surgical Shelf. It is a super short but super high yield review of the most important information for surgery.


Pros: 1) Super short so you can read through it in a weekend. I read through it at least 3x (maybe more) during my cores and I am happy that I did because although it is short, it has so much valuable information packed into those pages that you need a couple of read throughs to really get a good grip on all of it.  2) Questions in the back- you will find that there are not a lot of pure surgery shelf type questions out there (UWORLD only has 140 dedicated surgical questions but I'll get to that in a bit), so the 180 questions that Dr. Pestana has so graciously given us are really helpful.  Obviously they are not the same type of question as UWORLD/NBME but they are helpful.


Cons: Only a review book. It hits most of the high yield and important material for shelf, but there are still gaps that you will have to fill in with either a textbook, experience on the wards or an explanation from a QBANK.


Case Files: Surgery 


You will become well accustomed to hearing about the Case Files Series for all of your cores, and you will find that some are more helpful and essential then others. I made it through about half of Case Files and I liked it, but I started late when it came to reading it, so I knew that I didn't want to really spend time reading the rest of it towards the end of my core.


Pros: Good layout. I really like how they layout everything by starting with a vignette, then going into clinical implications, important terminology related to the case/disease pathology and then breaking down medical management and surgical interventions.  And there are questions for each case at the end. So, it actually is a good supplement to Pestana because if you need some more information, if you can find a relevant case in Case Files, most likely they will have more information to help for a better understanding.


Cons:  1) Difficult to get through if you don't start early. I just alluded to this earlier. 2) Typos and Errors - the surgical Case files is riddled with these which just gets frustrating. 3) sometimes too much information for each case.


All in all, it is a good but that is not necessary for doing well on the shelf but will likely not hurt you either.


Shelf Specific: Online Resources 





This is the gold mine of information for M3, M4 and Intern year. Basic subscription is free and you get access to hundreds of 10-30 minute videos on every possible topic for each core.  Dr. Williams creates these videos with whiteboard illustrations and explains everything in such a simplified and great manner. I made it through the Surgery videos about 1.5 times but I wish I really discovered the gold mine earlier. I also really liked reading my Pestana long with reviewing the Onlinemeded videos because Dr. Williams outlines his videos very similar to how Dr. Pestana lays out his book.


Cons: If you don't particularly enjoy learning from videos then this is likely not for you, but otherwise...there is no cons in my opinion.


I am considering updating to a premium description for the rest of the summer and if/when I do, I will give a further update on what the full membership has to offer. But honestly, the videos are plenty in themselves.


Emma Holiday Ramahi Video Review 


Dr. Ramahi started making review videos and PDFs for her Step CK during her third year of medical school. She has various videos/pdfs for four of the major cores including Surgery. She essentially pulls together a high yield review based on various sources that she used to study for Shelf and CK, and I found it to be a great review the weekend before Shelf.


It is exactly what it says by saying that it is a review so I wouldn't use it as my primary source of studying, however, it is a great way to pull together everything the weekend or the morning of the test. I watched it once at regular speed during the weekend and I actually watched it again the morning of my test on 2.0.


Pros: Listed Above


Cons: Only a review, still have to supplement with other resources.


Question Banks/NBMEs 



Tried and True.

  1. Do your surgical UWORLD questions

  2. You will hear many people say that surgery shelf is medicine which I personally think is a misnomer, but I also understand what they are trying to get at.  The majority of your surgical shelf is based on pre-op and post-op care so it is Medicine. So, you have to know your medicine to be able to effectively answer those questions.  I found that by just really paying attention and being inquisitive during rounds and the pre-op and post-op care of our patients while on the wards, you actually learn a lot of that information (shocker), but I still recommend doing Medicine UWorld Questions.  Keep your Medicine subjects to Cardio, GI, Pulmonary/Critical Care, Renal and Endocrine. I did about 200 of those UWORLD Questions and I think that was sufficient to get the important topics

NBME Assessments 


I recommend doing at least 1 but I did 3 and was happy that I did.  I saw a lot of repeat questions or very similar questions on the real thing.  Of course the biggest draw back is that they cost $ but its only $20 per test, so I personally think its a worthwhile small investment.


The Test Itself


They key to Shelf exams is time management.  The exam is 3 hours long, 110 questions with NO breaks, so you have to mentally prepare yourself for that.  Because I was very concerned with running out of time (based on my speed that it was taking me to get through UWORLD questions and the practice NBMEs), I made sure that I really focused on not spending too much time on a question.  However, the question stems are SUPER SUPER SUPER LONG. Even the straight forward questions had super long stems, so that is a significant reason why I am a big proponent of doing at least one NBME (if not more), just to prepare yourself for that.  For Step 1, there were a lot of long stems but they were also intermixed with a 2 line question stem, but on Shelf the significant majority were super long stems. So, get your timing down and make sure that you are well fed, well energized and well hydrated before going in because again there are NO breaks.

All in all, this is a lot of information but I hope it's helpful.  In my opinion, I think the big four are Pestana, Onlinemeded, UWORLD and NBMEs with Emma's review. Obviously everyone is different but this combo worked for me and hopefully it can work for you too! If you have any questions, comments or additional advice please post below! ALSO, I added hyperlinks to all of the resources (Amazon for the books).


Thanks for reading!





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