This rotation, my mid and final site visits were fortunately conducted in person, as my site evaluator works at the hospital where I was rotating. This was a nice change compared to my prior site visits, which were all conducted via Zoom, as I also was able to see him during my first two weeks in general surgery even though we were not on the same team. It was much easier to be more personable.

This rotation was also different in the sense that I presented SOAP notes as opposed to H&Ps. During my mid evaluation, we discussed condensing my HPI/Subjective to be more concise with greater focus on overnight/significant events as well as including more specific details when documenting abdominal exam findings in terms of laterality/location of quadrants and characteristics of contents through different drains, such as JP drains, NG tubes, and foley catheters. We also discussed the importance of noting I&Os both over 12 hours and over 24 hours. Additionally, we discussed the 5Ws of post-op infection – Wind, Wound, Water, Walking, and Wonder drugs – which are important to consider in all patients post-op, noting the timing of certain symptoms.

I was able to apply the feedback I received and improve when writing my SOAP notes for my final evaluation, including specific details with regard to color, quantity, and consistency drain contents. During my final evaluation, we discussed the hyperkalemia cocktail, as one patient became hyperkalemic post-op, and noted the need for calcium gluconate with EKG changes in addition to sodium bicarbonate, dialysis if needed, insulin/dextrose, albuterol, Lasix, and kayexalate. We also discussed the different dosing regimens of Acetaminophen for pain for patients younger than 60 [975 g q6h or 4 g/day] and patients older than 60 [975 g q8h or 3 g/day]. Lastly, for patients who go to the gym often, we discussed the importance of considering things that could lead to increased dehydration, such as the use of supplements like protein and creatine, when patients present with symptoms of nephrolithiasis.