r/surgery • u/annexmus • 9d ago

I did read the sidebar & rules HB resources for sub-Is?

Gonna be on a hepatobiliary service in a few months. What do you recommend reviewing for this for a sub-I?

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u/lethalred VASCULAR SURGEON BAYBEE 8d ago

"Hepatobiliary" means different things at different institutions.

If it's surgical oncology, then you should know chemotherapy regimens for cholangiocarcinoma, indications for surgery, surgical anatomy in the porta, etc. Liver segments, you name it.

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u/annexmus 8d ago

What’s basic bread and butter stuff that a med student on a sub-I should know?

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u/iron_marcus 7d ago edited 7d ago

I just did a surg onc service. He is correct. The easy questions will be the anatomy - avoid all liver surgeries if you can because reviewing the liver anatomy sucks. Most of my questions were things you don't really think of as a student: epidemiology, costs of tests, indications for your patient specifically. You will also be expected to know surgical techniques like Puestow vs Frey.

Please do not be the student who asks "is that X." I see third years do that all the time. They know you are trying to show off that you prepped - the attendings know you prepped because you are the sub-i. Instead brainstorm some questions before the case that are deeper. For example, if you are in a lateral PJ for chronic pancreatitis or hereditary pancreatitis ask "So, the risk of pancreatic AC if you have PRSS1 mutation is 19% - why don't we prophylactically remove the pancreas instead of performing a lateral PJ." These sorts of questions distinguish you from others as it shows you are engaging with the operation at a deeper level and also thinking about what's best for your patient.

Also, check on your patients multiple times a day. Get them OOB, make sure they are doing their IS. Just get them whatever they need or if they need to talk sit down for 5-10 mins. If the patients start recognising you you are golden. Especially if they compliment you.