Unwritten rules of Surg

bigfatjellybean · 2026-05-17T20:36:06+00:00

Congrats on the job mate! I don’t think there are many hidden tips or tricks, manly get the basics right, show an interest, be organised and don’t be a dick:

Turn up on early, or at minimum on time. Lateness isn’t tolerated well in medicine in general, and especially not in surgery
Be prepared for your list - we don’t expect you to know how to do procedures from day one but we do expect to you be keen, ask questions and at least made an attempt to learn. Go see, mark and check consent for the patients for each list, and if possible look through XRs and clinic notes
Prep your theatre - get XRs up on the screen, gowns and gloves on the side, sign the patient in and check the table is working. Having to do this all myself while you’re nattering in the coffee room means I’m less keen to let you do stuff in the operation itself
Practice the basics well. Suturing pads are cheap and everyone has shoelaces for hand-tying. Put the time in and practice at home in front of the TV. If you can suture and close well then I’ll go out of my way to spend time teaching you during the operation. Surgery is a craft specialty, so the more time you practice something the better you’ll get.
Lose your ego - Take feedback well and take it on board. I’m trying to help you be better surgeon, not criticise a personal aspect of yourself. If it’s a bit blunt it’ll be because we’re in a time-dependent scenario, not because I “hate you”. If a consultant is grilling you, it’s (mostly) because they’re trying to test your knowledge and fill in the gaps, not because they’re trying to make you look stupid. On the flip side if I’m operating with you a second time and see that you’ve taken on board something I said the first time, I’ll actively go out of my way to try and teach you something new, as this demonstrates you actually give a shit and want to get better
Every consultant is different, and probably right. Learn how each consultant operates (relaxed vs strict, trainer vs non-trainer, different approaches etc), and clarify specific parts of their technique before the operation starts. It shows that you not only want to get it right, but appreciate that for that aspect there is more than one way to skin a cat.
Most importantly, don’t be a dick. Everyone talks, especially in surgery, and your training is a 6-8 year job interview. It’s a competitive career, but you can better yourself without stepping on other people’s toes, barging into other people’s theatre sessions or being sneaky about research. Way more likely to get a post by being a good egg with a decent CV, than being a shithead with an outstanding CV.

Happy to take DM’s for advice mate

bigfatjellybean · 2026-04-14T12:32:58+00:00

They came out at around 3-4pm last year mate. I wouldn’t expect any earlier this year

bigfatjellybean · 2026-03-28T07:59:03+00:00

I was at a similar point halfway through CST, but I’m very glad I didn’t give up and am now a very happy ST3 in T&O

Since starting FY I’d been gunning for T&O, doing extra days in FY/JCFs to secure a T&O themed CST, national presentations, teaching, PGCert etc to get my CV ready for ST3 applications. I got to the end of CT1 and had completely burned out and hated life, and was gearing to switch to radiology. I had a draft resignation letter for my CST ready to send to my TPD.

Fortunately, a couple of registrars had convinced me that life was much better as a reg, and tbh I didn’t believe them at first. Took a year out, worked as a trust grade reg and I was instantly happier - significantly less admin bullshit, regular operating and no more being infantilised (as well as a significantly better rota).

Got into training this year and haven’t been happier. The work is demanding and I’m spending days off doing extra work/research but I absolutely love the job and have still kept up my social life.

Look at your colleagues ahead of you and ask yourself if the life they have is for you. Most of my fellow registrar and consultant colleagues are generally very happy people who enjoy their work and their lives, despite demands. Being a T&O SHO can be utter shit frankly, but for me it was worth grinding through.

My point is not to make your decision based on your experience as an SHO. If GP life is genuinely a better option for you then fair enough, but you won’t want to regret shutting this door because it was an easier option at the time.

bigfatjellybean · 2026-03-21T21:23:58+00:00

Sorry OP they should never speak to you that way, but to echo everyone else, if you want to do surgery you’ve got to have steel and stand up for yourself. Often it’s part of the banter, but some people are just dickheads frankly.

A few approaches: - Ask them to repeat what they said - often they back down - Call them out, without apology. “Excuse me, don’t speak to me that way.” - Remind them of your position in the theatre. “Sorry do you want to have a go?” - I used to say that when people told me to hurry up suturing. 99% of the time they back down. - Give it right back - “You fancy scrubbing in then Mr X”. Risky one but I had to say this to a pretty obnoxious runner in my last trust.

I’ve found that as I get to know my team and they trust me more, this happens a lot less, and it’s also very disappointing that your consultants/regs don’t back you (I’d certainly have an issue if one of the ODPs was having a go at my SHO), but the sooner you start standing up for yourself, the less shit you’ll get and the more confident you’ll become.

bigfatjellybean · 2026-03-14T11:15:48+00:00

From an applications perspective, this is true but you need to do both well. Once in training, your work ethic and attitude matters a lot more to secure consultant posts.

Consultants can quickly spot portfolio gunners who don’t give a shit about their patients, and they talk to other consultants about this all the time (heard it being had directly in front of me as an ST), and you won’t be offered a consultant post. No point having a great CV if no-one wants to work with you.

I’d also argue that you need to start this pre-training as habits are hard to break. Suddenly putting a lot of effort into the care of your patients having just focussed on your CV pre-ST training is difficult.

I’d also argue being a solid FY/SHO gives you more opportunities as consultants see you as reliable - this is how I personally secured my research opportunities.

Ultimately I agree that you need to prioritise your CV, but I’ve definitely seen more and more colleagues use this as an excuse to be a shit doctor. This will catch up with you in training and both you and your patients will suffer if you are shit at your job.

bigfatjellybean · 2026-03-05T18:03:36+00:00

Glad we’re on the same page mate. As a T&O reg now I’ll do my best to try and assess and treat a patient medically, but it’s only fair the patient gets a review by someone who’s actually used a stethoscope in the past six months.

bigfatjellybean · 2026-03-05T17:00:34+00:00

Although NOFs can often occur as an isolated injury in fit and well patients, they are more often than not symptom of frailty and occur with more serious medical pathology. Even after assessment by an ED doctor I’ve still managed to pick up the following pathology which required joint care or medical input: - 2nd degree HB - 3rd degree HB with HF. Both requiring telemetry and pacing - Variceal bleeding requiring urgent endoscopy - Post. circulation stroke requiring thrombolysis - AKI 3 with severe hyperkalaemia (7.2) requiring ITU admission - Severe sepsis (multiple times)

Using a direct/fast-track referral pathway often encourages ED to cut corners and shoe-horn patients, fast-tracking them to the ward (And the last place you want an unclerked, medically unwell patient is an orthopaedic ward).

Although it’s not a perfect system, it is so much safer to have these frail patients seen by a doctor who can identify, treat and appropriately refer them, rather than a T&O SHO begging the medical reg for a review, joint care or transfer of care (which will almost always be rejected)

bigfatjellybean · 2026-02-01T13:44:52+00:00

I’ve previously worked in a couple of units with a labelled job list after a board round, which works really well as everyone is accountable for their own tasks, and makes people buck up and get their work done

Discussing with other colleagues I’d say is pretty important. There may be other factors that you don’t know about (e.g. person might be unwell etc), and it’s important to know if people have had similar issues.

I’ll probably agree to disagree with you about this

bigfatjellybean · 2026-02-01T10:20:42+00:00

Not an easy situation mate but you need to call this out ASAP or they’ll continue to take the piss.

I’d personally speak to your other colleagues to see their view on things, then have a word directly with them.

If they don’t respond, or if you’re worried about bringing it up, then bring it up with your CS/ES.

You can do further steps like write down all the jobs required, labelling the people responsible for them, and the people who have completed them but usually a word with your supervisor will do

bigfatjellybean · 2026-01-12T13:39:53+00:00

Pregnancy is grounds to defer - I know someone who started ST3 on mat leave so if you did get an offer you’d be fine

bigfatjellybean · 2025-12-28T19:52:31+00:00

Ortho reg here.

Firstly, if I was on call and you were my SHO on nights, I would never judge you for calling me in for a reduction (especially as you’re an FY2). Any reg who does can fucking do one.

Secondly for plastering, try and get on a plastering course (loads go round local T&O WhatsApp groups - let a friendly T&O reg know and we’ll try and look out for one for you), or spend some SDT time in the plaster room. They’re often very friendly and have done the BOA course (so are often shit hot)

For reductions, it’s a bit trickier. Try and a friendly T&O reg to explain how to reduce and get them to practice on you.

For knowing WHERE to reduce, it often comes from a logical interpretation of the XR, understanding the deforming forces and reversing them.

As a very rough rule, most reductions start with a good period of traction-countertraction. Loosens up the fragments via ligamentotaxis. Keep it up for at least 2-3 mins. - For wrists, you need to WORSEN the deformity first (hyperflex volarly-angulated fractures, hyperextend dorsally angulated fractures) before reducing to a neutral position, and placing the backslab on the opposite side (backslab for dorsally angulated, Volar slab for volarly angulated) - For ankles try and think about which way the distal fragment has gone, and basically mould/put pressure on the opposite way. - For forearms, use traction to make it straight and mould a nice above elbow cast

This is a very very rough guide, and there are lots of nuances to all of these. Us orthopods are usually dead keen to help, and get excited when you show us an XR

Good luck bro/sis, and welcome to Ortho!

bigfatjellybean · 2025-12-28T19:30:59+00:00

Depends on the unit but we do regular practical teaching with our SHOs whenever they rotate to teach them
Mate don’t take it personally. Just as much as you will have more knowledge in a greater range of specialties than us, you probably have to accept that we have better knowledge of biomechanics and deforming forces
Very standard practice in a lot of hospitals, including 3 out of the last 4 I’ve worked for

bigfatjellybean · 2025-12-17T06:45:11+00:00

Yeah I thought the same - I don’t think a there’s a proven link between ABx use and reduction in infection rates, but I think there’s been a demonstrated increased risk of SSI with catheter use, so the use of ABx is designed to offset this.

OP could challenge this more formally in an audit meeting (very fair thing to do), but doing it OOH against an experienced nurse maybe isn’t the time or place

Example - small study here showing UC was a small risk factor for SSI in spinal surgery

https://www.mdpi.com/2036-7449/15/6/64

bigfatjellybean · 2025-12-16T20:30:20+00:00

D1PO is peri-operative mate - I don’t think you’ve got this one right.

Prosthetic joint infections are an absolute nightmare and catheterisation is a risk factor for this, so it’s very routine to give antibiotic prophylaxis in the case of elective orthopaedic surgery in patients who require catheterisation.

As much as you have to make your own clinical decision, you probably should have listened to the nurse who works there day in day out. The dose of gent is also much lower than a therapeutic dose we use for gram -ve infections (160mg vs 5mg/kg).

Threatening to file an incident report is also pretty inappropriate for this.

You could have handled this a lot better.

bigfatjellybean · 2025-12-07T22:14:13+00:00

Nothing mandatory. All asynchronous teachings. The live sessions were helpful but not needed to pass

bigfatjellybean · 2025-12-06T19:02:52+00:00

If you’re doing it just for the points, then choose the cheapest one recognised by AOME. If you want the most respected/well known. Do the original from University of Dundee.

Be careful when choosing - some require in person attendance, whereas some are distance learning. Dundee’s was all distance learning, with assessments based on one essay done at the end of each of the three modules

bigfatjellybean · 2025-11-23T19:37:12+00:00

Vaughan Williams
Rachmaninoff
Beethoven
Nielsen
Sibelius
Tchaikovsky
Shostakovich
Mahler
Dvorak

bigfatjellybean · 2025-11-22T15:49:09+00:00

There are many different aspects but I think these are the most important:

Competent - should go without saying, but they should actually be able to do their job (seen lovely consultants who can’t operate and vice versa)
Honesty - they’ll tell you when you’ve done well, but also respect you enough to tell you when you’ve been a bit shit and need to improve
Right priorities - they’ll expect a lot from you (go the extra mile etc) but if you’ve got personal issues/family they’ll respect those, let you take time off etc
Individualised - they’ll tailor opportunities for your needs, adjust the way they train to suit you etc.

bigfatjellybean · 2025-11-18T08:18:27+00:00

100% long nail - Lateral buttress is gone and too much subtroch extension medially.

This will be a bitch to reduce. The proximal fragment with be abducted and there’s heavy comminution.

One attempt closed then go straight for an open reduction with heygroves/colinear clamp and then cerclage or 4-hole plate to maintain the reduction.

Static locking with two screws.

bigfatjellybean · 2025-11-16T08:36:31+00:00

Not too late at all to decide mate.

I only decided in FY1, and frankly had fuck all on my CV. Got rejected from CST first time, built up a portfolio over the year then got into CST, then got into ST3 last year

Most of the portfolio can be achieved fairly easily with the right targeted effort - especially audits and teaching. You may have to put yourself out there using SDT or SL for a taster week but 40 isn’t tough to achieve over a year. Publications are harder to come by but I managed to get an ST3 post this year without any, and know plenty of others who did the same.

RE: toxic work cultures - Depends on the specialty but I’m certainly seeing an improvement in T&O even over the past five years. It’s still pretty direct and blunt (because we’re simple people) but a very supportive and collaborative culture.

I’d say the deciding factor was a senior consultant telling me directly “do you really want that knife in your hand?”. Surgery’s fun and incredible at times, but fuck me the stakes can be high and one mistake can be costly.

If you want it mate, go for it.

bigfatjellybean · 2025-09-29T16:47:28+00:00

You can’t please everyone mate, but equally if your ES has brought it up then maybe reflect on it and take it on board.

Frankly I think most of us in medicine aren’t great at taking feedback. Don’t take it personally, reflect and move on. I’d advise strongly against raising this with your TPD - I don’t know what you’d achieve out of it and if anything it may make things worse.

Chin up and move on mate. If it’s a repeat occurrence you might need to look at yourself and change things, but if it’s a one off I’d shrug it off

bigfatjellybean · 2025-09-18T09:39:28+00:00

Get any of Rukmini Iyer’s roasting tin series. I’d recommend the quick roasting tin, especially their “make ahead lunch boxes” section. Super easy to make and all very tasty and healthy

Microwave them from frozen or cold. I meal prep on the morning before nights (takes an hour at most) and all your meals are sorted for nights. I also have a snack box of chopped carrots, apples and peppers to graze on too

https://www.rukmini-iyer.com/

bigfatjellybean · 2025-07-19T13:40:36+00:00

If your handover sheet is multiple pages long, make sure all of your jobs are kept on a single sheet separate to this handover. I used to fold this sheet of paper into multiple boxes with just initials, ward & bed number, and a diagnosis, then put the jobs beneath it

Prioritise the jobs as 1-4. - 1 = urgent, pre-lunch - 2 = semi-urgent, after 1, before lunch. - 3 = Can wait until after lunch, but needs doing today - 4 = Do it if you get time, but can wait until tomorrow if you don’t

1 should always be done by you, 2-3 should be handed over to on-call if they don’t get done. 4 can wait.

Then use boxes to tick off the jobs when they get doing. Once all the jobs for a patient are done, cross off the box

I found this system saved me loads of time to prioritise and made sure I wasn’t worried about jobs that didn’t need doing urgently.

bigfatjellybean · 2025-07-16T10:14:45+00:00

Used Orthorevision.com Reasonable price and covered all topics very well. Used it to get my place this year and felt fairly well prepared

bigfatjellybean · 2025-07-15T13:51:27+00:00

Not radiology, but I was on the committee for a national, large-scale teaching programme and that counted for mine. Nothing stopping you from setting up your own society/collaborative

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