Clinicals
Surgery Oral Presentation Guide
Apr 11, 20268 min read
By Mike
By MikeBy MikeDisclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content below is not medical or clinical advice and is intended for educational purposes and general guidance only. Presentation expectations vary by institution and attending. Always adapt to your team's preferences.
Surgery presentations are shorter, faster, and more focused on objective data and clinical status than on differential diagnosis and reasoning. The surgical team wants to know: Is this patient recovering appropriately? Are there any complications? What needs to happen today to move them toward discharge?
Efficiency is valued. A concise, organized presentation will always be received better than a thorough but lengthy one. Aim for 1 to 2 minutes per patient on daily rounds.
This is the presentation you will give most often. The structure centers on objective markers of recovery.
One-liner with POD "Mr. Jones is a 55-year-old man, post-op day 2 from laparoscopic cholecystectomy."
Include the procedure name and post-op day (POD). This is the most important framing information for the surgical team.
Subjective Keep this brief. Focus on:
Example: "Patient reports pain is 4/10, improved from yesterday. He passed flatus overnight. No nausea or vomiting. He walked twice in the hallway with nursing."
Objective
Vitals: Current vitals and trends. The surgical team cares most about fever (sign of infection or complication), tachycardia (pain, hypovolemia, PE, infection), and hemodynamic stability.
I/Os: Total ins and outs from the past 24 hours. Include urine output, drain output (with character: sanguinous, serosanguinous, bilious, purulent), IV fluid intake, and PO intake.
Exam:
Labs: Report if obtained. CBC (white count trending), BMP (kidney function, electrolytes), lactate if relevant. Only report what was drawn.
Imaging: Any new results.
Assessment and Plan Brief and action-oriented. Focus on:
Shorter than a medicine admission. The surgical team wants to know what the problem is, what the relevant anatomy and imaging shows, and what the operative plan is.
One-liner "Mrs. Garcia is a 42-year-old woman with no significant surgical history who presents with 12 hours of RLQ pain, nausea, and anorexia consistent with acute appendicitis."
Brief HPI Chronological, focused on the surgical problem. Include onset, character, location, associated symptoms, and relevant negatives (no prior episodes, no peritoneal signs suggesting perforation, etc.). Keep it to 1 to 2 minutes.
Relevant PMH/PSH Prior abdominal surgeries (adhesions affect operative planning), bleeding disorders, anticoagulation use, cardiac or pulmonary history that affects anesthesia risk. Skip what is not relevant to the operative decision.
Medications and Allergies Focus on anticoagulants, antiplatelets, diabetes medications (insulin management peri-operatively), immunosuppressants, and drug allergies (especially to antibiotics and anesthetics).
Social History Smoking (wound healing, pulmonary risk), alcohol use (withdrawal risk), drug use, functional status, and who is at home (affects discharge planning).
Physical Exam Focused on the surgical problem. For an abdominal case: tenderness location, guarding, rebound, rigidity, bowel sounds, hernia sites, prior surgical scars.
Labs and Imaging Relevant results only. For appendicitis: WBC, CT findings (appendiceal diameter, periappendiceal fat stranding, perforation, abscess). For cholecystitis: RUQ ultrasound findings, LFTs, lipase.
Assessment and Plan State the diagnosis and the operative plan. "Assessment is acute uncomplicated appendicitis. Plan is for laparoscopic appendectomy. Patient is NPO, has IV access, received pre-op antibiotics. Consent obtained."
Shorter. Surgery presentations are 1 to 2 minutes for daily progress, 3 to 5 minutes for new patients. Brevity is expected.
More objective-focused. Surgery teams care about hard data: vitals, I/Os, drain output, wound appearance, bowel function. Less emphasis on history, differential diagnosis, and nuanced reasoning compared to medicine.
Post-op day is the frame. Everything is anchored to the procedure and expected recovery timeline. Knowing what is normal for POD 1 vs POD 3 vs POD 7 for a given procedure is essential.
Action-oriented plans. The plan should focus on concrete next steps: advance diet, remove drain, transition to PO pain meds, discharge tomorrow. Less discussion, more doing.
Bowel function matters. Return of bowel function (flatus, bowel movement) is a key milestone for most surgical patients, especially after abdominal procedures. Always ask about it and always report it.
Some surgical teams use an ultra-brief format called the "bullet." This is essentially a 30-second summary for stable, uncomplicated patients. Not every team uses this, but if yours does, the format is:
"Mr. Jones, POD 2, lap chole. Doing well. Pain controlled on PO meds. Passing flatus, tolerating clears. Afebrile, vitals stable. Wound is clean, dry, intact. Plan: advance diet to regular, continue ambulation, plan for discharge tomorrow if tolerating PO."
If you are unsure whether your team uses bullets, present in the standard format and let them tell you to shorten it.
Before scrubbing in, you may be asked to present the patient to the OR team or the attending. This is brief and focused on operative planning.
Patient and procedure: "This is [patient name], a [age]-year-old [sex] here for [procedure]."
Indication: Why are they having this surgery? One to two sentences.
Relevant anatomy and imaging: Key findings that affect the operation.
Allergies: Especially to antibiotics and latex.
Antibiotic prophylaxis: What was given and when.
Key PMH: Only what affects anesthesia or operative risk (cardiac history, pulmonary disease, bleeding disorders, prior abdominal surgeries).
Laterality/site marking: Confirm the correct site is marked if applicable.
Surgery attendings tend to ask questions that are more factual and anatomy-based than the clinical reasoning questions you get on medicine. Common types:
How to prepare: Review the anatomy and common complications for any procedure you are scrubbing into the next day. A 15-minute review the night before goes a long way.
If you do not know: Say so. "I'm not sure, I'll look that up before tomorrow." Then actually do it.
Forgetting to ask about flatus/BM. This will be asked about on rounds. Always ask your patient.
Not knowing the procedure. If you are following a post-op patient, you should know what procedure was done, what the indication was, and what the expected recovery looks like.
Long presentations. Surgery rounds move fast. If your team is rounding on 15 to 20 patients, a 5-minute presentation per patient is not sustainable. Trim it down.
Not examining the wound. Look at the incision or wound every day. Note whether it is clean, dry, and intact. If there are drains, note the output and character.
Skipping the I/Os. Input and output tracking matters in surgical patients. Know the numbers.
Not being in the OR. If there is an opportunity to scrub in, take it. Surgery attendings notice and value students who are present and engaged in the operating room.
Best of Luck!
— Mike