What advice do you have for medical students going into plastic surgery who do not have a home program?

Check out my blog post on matching without a home program!

I’m nervous about scrubbing into the OR for the first time…what do I need to know?

Check out my OR manners series!

What should I read to prepare for cases as a plastic surgery medical student or sub-I?

These are what I think are the best resources for medical students and sub-Is to start with for preparing for cases. Not an exhaustive list--there are tons of great resources out there--but when you feel overwhelmed or lost you should come back to these:

Hand: www.orthobullets.com for quick and dirty, AO Surgery Reference for a deeper dive https://surgeryreference.aofoundation.org/

Face: AO has face too, both trauma and peds craniofacial. It is just the best!

Flaps: www.microsurgeon.org. this is all of the basic info you need for basically every flap you might see. know this info before you scrub.

For everything else, pick good textbook and always start with that. I like either Janis's Essentials of Plastic Surgery or Grabb & Smith's Plastic Surgery

What to take it to the next level? Try an operative atlas. These tend to have much more specific detail about the steps of an operation, with lots of pictures and practical tips. I really like Kevin Chung's Operative Techniques in Plastic Surgery 

What advice do you have for how to behave as a sub-I, or what sub-Is and med students can do to make a good impression?

3 things that I’ve noticed that all of our very best and most successful plastic surgery sub-Is have in common: 

1. They help the residents. This is the biggest thing you can do to show that you are a team player and that you know how to anticipate. and though the attendings may be the ones who. Make the rank list in the end, they really do listen to the residents 

2. Know when to be quiet aka know how to read the room. Some obvious times I can tell you when you probably shouldn’t be talking are during induction, and anytime you’re operating on a patient who is awake, best just to let your attending take the lead on conversation. But just try to be aware of what is going on with the patient and the team, and if things seem tense, your best first move is to stay quiet so the team can focus on the patient

3. Be professional. Remember that as a sub-I, you are a guest in what is essentially a residency family. You may hear people making fun of other residents, but that doesn’t mean that it’s ok for you to do that. You may hear dirty jokes, but that doesn’t mean it’s ok for you to tell a dirty joke, it’s going to be perceived differently because of your position. and for the same reason you should avoid saying anything negative about other programs or other faculty members even if you hear someone else talking negatively - every minute of your sub-I is a job interview, and you want to come across as professional and positive, even to the oldest and most curmudgeonly surgeon on the team. 

Check out my insta videos for more details on how to be the best sub-I you can be: how to prepare for your plastics sub-I, sub-I tips, more sub-I tips, and even more sub-I tips.

What should I have in my pocket as a plastic surgery med student or sub-I?

5 things every med student and sub-I should have in their pocket for their plastic surgery rotation!

✍️ a pen: for you, and to lend to your resident/attending when they forget theirs 

📓 a notebook: if you take notes on your phone, it will look like you’re not paying attention. Write things down on paper!

✂️ trauma shears: plastics has a lot of dressings! Be prepared when the attending/resident says “anybody have scissors?”

🖊️ a marking pen: these can be tricky to track down when you need one to mark a patient on rounds! If you have one, you’ve just solved a problem for your team 😎 

🍫 a snack: plastic surgery days can get crazy…eat when you can and don’t forget to take care of yourself 🤗 

How do I chart check and pre-round for my plastic surgery rotation?

Check out my pre-rounding video on instagram.

What advice do you have for residency interviews?

This is the best piece of advice I got about interviews. It goes like this:

Your interviewers aren’t necessarily going to remember every little thing that you said, but what they are going to remember is how they FELT during your interview. So you want to leave the room with a positive feeling not only about YOU but also you want the interviewer to feel good about themselves and their work too. One of the biggest mistakes I see people make is to ask questions at the interview that are negative. Things like: what’s the biggest weakness of your program, how do you support a resident who is struggling, how are you adjusting after X faculty or resident leaving. First of all: you’re unlikely to get any useful information out of these questions, like they’re not gonna tell you any dirt even if there is dirt, and second, these questions are going to put them on the defensive and potentially leave them with a negative feeling about the interview, and therefore maybe a negative feeling about you. Do your research about programs and think critically about any problems that you hear about, but the interview just isn’t the place for airing of grievances. So stay positive.  Ask instead: what are you PROUD of about this residency, what are you looking FORWARD to, what do you think the greatest strengths of this program are, what are the common characteristics of your most successful residents. These questions are still going to give you information about the program, but because they are framed positively they’re going to be much better received and make sure that you leave a the room with good vibes.

Don’t try to “gotcha” anybody with tricky questions, and don’t try to dig for dirt or drama. The interview room just isn’t the place for that, and if you’re looking for a vibe check on the program and how things are going, you can get that just as easily by flipping the question into a positive (what are you looking forward to, what are you proud of, etc). This is your time to show off your positive attitude, and to connect on a personal level. The actual information being exchanged is secondary.

What study tips do you have for interns?

Studying intern year is almost impossible but here are 3 different strategies that I think work well:

1. Keep an article in your pocket: Go to the CME section of the top journal in your field. Print out an article. Put it in your pocket with your list. Try to read a few paragraphs throughout the day whenever you have a few minutes. Even if it takes you a week to read one article, an article a week is a whole lot more than nothing. 

2. Do 2 questions per day: Maybe you’re somebody who learns best from questions. get a copy of last year’s version of your inservice exam or ABSITE or whatever, print it out, and put it by your bed. Each night right before you go to sleep do two questions. JUST. TWO. and read the explanations. Before bed is an optimal time in terms of memory consolidation, and if you just do two questions a day you’ll probably actually remember them. If you hate paper you could do an Anki deck and set a reminder alarm, whatever works for you, but two questions a night five nights a week, that’s 40 questions a month which is honestly huge.

3. Make a textbook spreadsheet: This is an advanced tip: try making a textbook spreadsheet. Reading a whole textbook is a great way to lay a foundation for all of the knowledge you’re going to gain in residency, and it helps you avoid the trap of only reading about your favorite topics. Make a spreadsheet to use as a checklist to keep track of chapters as you read them, and do some math to figure out how many chapters you need to read a week to finish the textbook in a year. You can even set a lil formula to count down for you how many chapters you have left to go. Keeping track in this way made it easier for me to skip around and read different chapters based on what fit with the rotation I was on. This is a daunting task (and not something I actually did til pgy-2 year!), but I think it really helped me stay organized and motivated, and set me up for success in the years that followed. 

How do you write a strong CV and personal statement for your residency application?

Check out my tips for personal statements and tips for CV/resume on instagram.

How should I pick my sub-Is or away rotations for plastic surgery?

I made a video for insta with advice for picking away rotations!

As a sub-I or med student, what information should I know about patients to be prepared and make a good impression?

I remember hearing this advice to “know your patients” all the time as a med student and not really understanding what that meant SO, now that I’m on the other side I’m going to try to make it a little more practical

First off, things you should know about ANY surgical patient before stepping into their OR

1. Have they had surgery on this part of the body before? This is always important in surgery because if they have, it means the surgery might be more challenging or different because of scarring. If they’ve had a surgery before, you should know when the surgery was, what they had done, and ideally who did it. 

2. Do we think they are going to have bleeding problems? All surgery involves bleeding so we basically always want to know if they have a history of coagulopathy, if they’re on blood thinners, and ideally their starting hgb so we can trend it after surgery

3. Do we think they are going to have clotting problems? It’s not fair that we have to worry about both sides but we do. DVT/PEs are a common and serious complication of basically any surgery so you should know if your patient had one before - this can change how we manage them after surgery

4. Does the patient take pain meds at baseline? That probably means they’re going to need more than what we expect after surgery 

5. Does the patient smoke, drink alcohol, or use drugs? we we do surgery are taking people out of their normal routine and environment and sometimes that leads to problems. if people start  having unexpected symptoms after surgery or even just getting cranky, you wanna to know if it might be related to withdrawal 

6. Does this patient have any foreign objects in their body? do they have a pacemaker, a port, an artificial hip, mesh, a vascular graft, a breast implant, it’s just good to know that patients have these so that we don’t mess them up. For example if they have an artificial hip, you can’t put the bovie on that side, if they have mesh from a hernia repair that makes getting into their abdomen more complicated, if they have an artificial heart valve they may be at increased risk of infection, maybe they have a tissue expander in and that has metal so they can’t get an MRI, there are a million reasons that it’s just good to know what foreign objects your patients have.

It think one of the biggest wins you can have as a med student is knowing information about a patient that other people in the room don’t know. If you know this stuff before going into your cases, you’re going to be prepared to seize that opportunity when it comes. And that’s what it means to KNOW your preop patient.