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We are excited for you! You are about to embark on an exhilarating journey that will be filled with fear, awe, pride, fatigue, reward, and fun. It will, in all likelihood, be a transformative experience that you will look back on with warm nostalgia. While we hope you too are excited about starting your residency, we also recognize that it may seem a bit daunting. You have, no doubt, heard a lot of fanciful stories about the surgical intern year, and you’ve watched some hardy souls weather the experience. But attending an opera or watching a boxing match is a whole lot different from singing or slugging it out in one.


When Columbus set sail for the New World, his destination on the map was blank. In between Spain and the edge of the world, some helpful cartographers penciled in storms and sea monsters. Like Columbus, you too are sailing into unfamiliar territory. And in surgery the storms and monsters are real enough. But while all people need to captain their own ships and embark on their own journeys, in this case the map is not totally blank. This book is just one of many resources to help guide your forward motion.


We have written this book with the goal of helping you, the soon-to-be-new intern, to develop a deeper understanding of all the “basics”—and nothing more. We have worked hard to keep this book as focused, succinct, and clinically relevant as possible. For example, the book does not include any information about how to manage pancreatic cancer, because as an intern you are never actually going to do that anyway. It does have chapters on how to replete electrolytes, how to triage multiple simultaneous admissions and/or consults, and what your role should be during a trauma. Indeed, we have focused on those areas where you might be expected to already know what to do (even if, like many new interns, you don’t). In some cases we simply explain the potential significance of various symptoms and signs, so that you will know when you should call for help.


But how did we come up with the final list of topics we wanted to cover? We started with the “prerequisite” knowledge that an expert panel at the American College of Surgeons (ACS) felt that all medical students should know prior to starting their internship. The list is long—too long. It includes a lot of topics that are already understood by 99% of medical students or not actually that useful in everyday practice. We didn’t want to include any of those topics, as that would be a waste of your time and needlessly decrease the signal-to-noise ratio. In order to help sort it out we therefore conducted a survey of “real live interns” during their fourth month of internship, while they could still remember what it was like on their first day. Using a structured instrument we determined which topics ...

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