SURGERY CLERKSHIP - PRE-OP + PERIOPERATIVE CARE
YEAR 3 | PAGE 29E - RISK STRATIFICATION + OR READINESS
WHY THIS CLERKSHIP MATTERS Surgery tests timing and sequence: does the patient need stabilization, optimization, imaging, observation, drainage or an operation - and what must happen first? On the service, know the indication for the procedure, the relevant anatomy, the major perioperative risks and the plan if the patient deteriorates.
A. PREOPERATIVE DECISION FRAME
| Decision point | Ask yourself | What it changes |
|---|---|---|
| 1. Indication + urgency | What problem is surgery trying to solve? Is this emergent, urgent or elective? | How much time exists for optimization versus immediate source control or hemorrhage control. |
| 2. Physiologic stability | Is there airway, breathing, circulatory, infectious or metabolic instability now? | Stabilize first when instability changes the sequence; involve senior/specialty help early. |
| 3. Cardiopulmonary risk | What comorbidity, functional limitation or active cardiopulmonary problem increases perioperative risk? | Whether more evaluation or optimization would actually change management or timing. |
| 4. Medications + bleeding | Anticoagulants/antiplatelets? diabetes agents? steroids? antihypertensives? allergy history? | Hold/continue/bridge or monitor medications according to the procedure, indication and current guidance. |
| 5. Infection + VTE prevention | What antimicrobial prophylaxis, thrombosis prevention and device strategy is appropriate? | Prevents avoidable perioperative complications without delaying an urgent operation. |
| 6. Consent + logistics | Does the patient understand indication, alternatives, major risks, anesthesia/blood needs and expected recovery? | Clarifies goals, readiness, site/procedure verification and postoperative disposition. |
B. WHAT A STRONG SURGERY STUDENT KNOWS BEFORE ROUNDS / OR
- One-line surgical problem: diagnosis/syndrome + severity + operation/procedure + postoperative day when applicable.
- Operation logic: indication, key anatomy, what was found, what was done, drains/tubes, expected milestones and major complications.
- Daily safety: vitals/hemodynamics, oxygen, pain, I/O and urine output, diet/bowel function, wound/drains, mobility, VTE prophylaxis, antibiotics and lines.
- Disposition: what must be true for discharge, what needs follow-up, and what finding would make the patient unsafe to wait. High-value surgery video resources Lecturio Surgery - Kevin Pei, MD (general surgery video library) OnlineMedEd - clinical video library / Surgery framework 2026/27 clerkship-expanded edition - verify school and official exam updates before testing