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When I was a surgical resident, I would get asked often how I survived each day and if it resembled the medical dramas on TV (when I trained, ER was popular, nowadays its Grey’s Anatomy). I started my surgical training before work hour restrictions. For nine months that year, I was on call every other night. To be specific, my typical workday was at least 36 hours long. And to get a little time off, we would usually swap weekends with one another where every other weekend we would stay from Saturday morning to Monday evening so the other intern could have half of Saturday and all day Sunday off. I survived each day with a great deal of planning, learning, and doing.

Each day started with pre-rounding. This was when I would go around and see all of my patients. I would talk to the patient’s nurse and look at the chart to figure out if there were any events since I had last been there. I would gather vital signs, lab results, and look at any new x-rays. After pre-rounding, I would meet with the entire team (usually a chief or senior resident, junior resident, a couple of interns, and some medical students). We would then go around as a team and come up with a plan for each patient. We would write the orders, make to-do lists, and then head to teaching conference if there was one that day, or to the OR. Sometime during the day we would round again with the attending surgeon.

In between cases I would follow up on new tests we had ordered, discharge the patients ready to go home, assist in the OR, and deal with any new patients that arrived on the service. Some time towards the end of the day, the team would sit down and run through the list of patients. If I was on call for the night, I would put together a to-do list of things to check up on. At a junior level, what it takes to be a successful resident is the ability to gather data, present it to your supervisors, and make a list of the things they tell you to do. If you take care of all those items before you go to bed or go home, you will be ok. As the on-call doctor, I would get calls from the nurses with questions about the patients, get called to the ER to see new patients and get ready again for rounds the next morning. Sometimes I would get to sleep, sometimes not, depending on how busy things were.

Surgical training is an old-school apprenticeship. You start off with little responsibility and a great deal of supervision. As you advance up the training ladder, you get more and more responsibility and less and less supervision.