For my surgery rotation evaluation, I was assessed by Professor Mike. This rotation’s format was slightly different from what we were used to because we had to write eight SOAP notes instead of long history and physicals. I appreciated the opportunity to practice SOAP notes before graduation. Professor Mike also conducted the site evaluation differently. My cases focused on SBO, appendicitis and cholecystitis. Instead of simply presenting my cases as we had in the past, I was asked questions about the cases I wrote. These questions challenged me to think beyond the immediate details, requiring higher-level reasoning and integration of knowledge from all my rotations. I found this approach very helpful because it allowed me to demonstrate my understanding of the cases in depth. For instance, he asked me what alternative pain management options I would consider besides morphine, which I had already written about. He also asked how I would manage a post op patient after an SBO caused by an incarcerated hernia. This experience helped me connect my  knowledge with practical application, enhancing my confidence in managing surgical cases.

For the final evaluation, we began by discussing the article I had written about the use of a JP drain after laparoscopic cholecystectomy. The article concluded that using a JP drain provides no postoperative benefit and actually prolongs hospital stays while increasing patient discomfort. Professor Mike mentioned that JP drains are not commonly used at the hospital he works at. But during my rotation at QHC, I saw them being used frequently. This highlighted how practices can vary between hospitals. I then presented a case about a patient with diverticulitis who was referred for an ER consult. We discussed that surgery is not always necessary for diverticulitis and explored conservative management options for such patients. Finally, we reviewed another SOAP note on cellulitis. Professor Mike asked how I would differentiate cellulitis from necrotizing fasciitis, prompting a discussion on key clinical features and diagnostic strategies.

During this final site evaluation, I was able to reflect on my progress throughout the clinical year. I confidently answered all the questions about my case, going beyond what I had written. Thinking outside the box helped me deepen my understanding of the concepts and approach them at a higher level, which is important as I prepare to begin my career.