How to present on surgery rounds
On surgery, a great presentation is a short one. Morning rounds often move through the whole list before the first case, so you get 60 to 90 seconds per patient, and every sentence has to earn its place.
- Target
- 60 to 90 seconds on morning rounds, 2 to 3 minutes for a consult
- Lead with
- Post-op day, outputs and the plan for today
Here is the format surgical teams expect, a word-for-word example from a fictional post-op patient, and the questions that tend to come up in the OR.
What your attending listens for
Surgical teams round fast because the first case starts early. Brevity wins. Lead with the post-op day, then the output from every tube and drain, the return of bowel function, and the one thing keeping the patient in the hospital today.
The structure
Step 1: ID line
Name, age, and post-op day from the procedure, or hospital day and diagnosis for a patient managed without surgery.
Step 2: Overnight and subjective
Pain control and whether it is oral or IV, nausea or vomiting, flatus or a bowel movement, walking, and how the diet is going.
Step 3: Vitals and strict ins and outs
Tmax and current vitals. Total 24-hour ins and outs, then the breakdown: urine output in mL/kg/hr, NG tube, and each drain by volume and character (serosanguineous, bilious, purulent).
Step 4: Focused exam
The abdomen (soft, distended, tender) and the incision or dressing: clean, dry and intact, or erythema and drainage.
Step 5: New labs and imaging
Only this morning's results that matter: WBC, hemoglobin, platelets, creatinine, potassium, lactate, or a new CT or KUB.
Step 6: Plan in three bullets
Diet, tubes and disposition. Advance the diet? Pull the NG tube, Foley or drain? Switch to oral pain medication? When can the patient go home?
A word-for-word example
Step 1: ID line
Ms. Davis is a 54-year-old woman, post-op day 2 from a laparoscopic cholecystectomy for acute cholecystitis.
Step 2: Overnight and subjective
Overnight she was afebrile. Her pain is controlled on oral acetaminophen and ibuprofen, she is passing flatus, she walked three times, and she is tolerating a regular diet.
Step 3: Vitals and strict ins and outs
Tmax 98.8°F, heart rate 74, blood pressure 124/78. Urine output was 1,400 mL over 24 hours, and her JP drain put out 15 mL of serosanguineous fluid.
Step 4: Focused exam
Her abdomen is soft and nontender, and her port sites are clean, dry and intact.
Step 5: New labs and imaging
White count is down to 8.2 from 13.4, and total bilirubin is 0.8.
Step 6: Plan in three bullets
She is progressing as expected. Today we will pull the JP drain, stop IV fluids, and discharge her home this afternoon with clinic follow-up in 2 weeks.
Ward pearls
- Look at the incision and the drain bulb yourself on prerounds. Never report "dressing intact" without checking.
- Know drain output by shift, so you can say whether it is trending down.
- Put every post-op fever in context with the 5 Ws: wind (POD 1 to 2; think pneumonia and aspiration, since the evidence that atelectasis causes fever is weak), water (POD 3 to 5), wound (POD 5 and later), walking (DVT and PE), and wonder drugs.
- Never say "labs are within normal limits." Give the actual WBC, hemoglobin and creatinine.
Classic pimp questions
- The boundaries of Calot's triangle and the critical view of safety
- The Tokyo Guidelines for acute cholecystitis, Charcot's triad and Reynolds' pentad
- The Holliday-Segar 4-2-1 rule for maintenance fluids, and lactated Ringer's versus normal saline
- Ranson's criteria and the revised Atlanta classification for acute pancreatitis
Not sure how to field them? How to take the questions
Practice it out loud
A script you have read is not one you can say. Present a fictional patient to an AI attending who cuts in, asks why, and grades you on a rubric, then drills whatever you missed.
Try a free caseOne case, free. No signup, no card.
Other rotations
Educational content with fictional patients, not medical advice. Teams and institutions differ: follow your attending, your institution's protocols and current guidelines.