Clinicals
Presenting on Surgery Rounds
by Mike
Apr 11, 2026 · 7 min read
Clinicals
by Mike
Apr 11, 2026 · 7 min read
Surgery presentations are shorter and faster than medicine presentations. They lean on objective data and how the patient is recovering, not on the differential. The team wants three answers: Is this patient recovering the way they should? Are there complications? What has to happen today to get them closer to home?
Speed counts. A tight, organized presentation will always land better than a thorough, long one. Aim for one to two minutes a patient on daily rounds.
This is the one you'll give most. It's built around objective signs of recovery.
"Mr. Jones is a 55-year-old man, post-op day 2 from laparoscopic cholecystectomy."
Always give the procedure and the post-op day (POD). For the surgical team, that's the frame for everything else.
Keep it short. Cover pain and how well it's controlled (is it better, are they using fewer PRNs?), nausea or vomiting, flatus or a bowel movement, walking (how far, and with help or without?), and anything new.
Bowel function matters because it decides when the diet advances and often when they go home.
For example: "Pain is 4/10, better than yesterday. He passed flatus overnight. No nausea or vomiting. He walked the hallway twice with nursing."
Vitals: current values and trends. Surgery cares most about fever (infection or another complication), tachycardia (pain, low volume, PE, infection), and whether they're hemodynamically stable.
I/Os: the last 24 hours in and out. Include urine output, drain output with its character (sanguineous, serosanguineous, bilious, purulent), IV fluids, and PO intake.
Exam:
Labs: only what was drawn. A CBC for the white count trend, a BMP for kidney function and electrolytes, and lactate if it's relevant.
Imaging: anything new.
Short, and all about what happens next:
This is shorter than a medicine admission. The team wants to know the problem, what the anatomy and imaging show, and the operative plan.
"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."
In order, focused on the surgical problem. Include onset, character, location, associated symptoms, and the negatives that matter (no prior episodes, no peritoneal signs of perforation). One to two minutes.
Prior abdominal surgery (adhesions change the operative plan), bleeding disorders, anticoagulation, and cardiac or pulmonary history that changes anesthesia risk. Skip whatever doesn't bear on the decision to operate.
Focus on anticoagulants, antiplatelets, diabetes meds (insulin needs managing around surgery), immunosuppressants, and drug allergies, especially to antibiotics and anesthetics.
Smoking (wound healing, lung risk), alcohol (withdrawal risk), drugs, functional status, and who's at home (for discharge planning).
Focused on the surgical problem. For an abdomen, that means where it's tender, guarding, rebound, rigidity, bowel sounds, hernia sites, and old scars.
Only what's relevant. For appendicitis, the WBC and the CT (appendiceal diameter, fat stranding, perforation, abscess). For cholecystitis, the RUQ ultrasound, LFTs, and lipase.
Give the diagnosis and the operative plan. "Assessment is acute uncomplicated appendicitis. Plan is laparoscopic appendectomy. She's NPO, has IV access, got pre-op antibiotics, and consent is signed."
It's shorter. Figure one to two minutes for daily progress and three to five for new patients. Brevity is expected.
It's built on hard data: vitals, I/Os, drain output, how the wound looks, bowel function. There's less history, less differential, and less back-and-forth reasoning than on medicine.
The post-op day frames everything. It's all measured against the procedure and the normal recovery timeline, so you need to know what's normal on POD 1, POD 3, and POD 7 for that operation.
The plan is a list of actions: advance the diet, pull the drain, switch to PO pain meds, discharge tomorrow. Less talk, more doing.
Bowel function matters. Flatus or a BM is a milestone for most surgical patients, especially after abdominal surgery. Always ask, and always report it.
Some teams use a 30-second format called the "bullet" for stable, uncomplicated patients. Not every team does, but if yours does, it sounds like this:
"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're not sure whether your team uses bullets, present the standard way and let them tell you to cut it down.
Before you scrub, you may be asked to present the patient to the OR team or the attending. Keep it short and about the operation:
Surgery attendings tend to ask more factual, anatomy-heavy questions than medicine attendings do. Expect things like:
Go over the anatomy and common complications for tomorrow's cases the night before. Fifteen minutes goes a long way.
If you don't know, say so: "I'm not sure. I'll look it up before tomorrow." Then actually do it.
Forgetting to ask about flatus or a BM. Someone will ask you on rounds, so always ask your patient.
Not knowing the operation. If you're following a post-op patient, know what was done, why, and what recovery should look like.
Talking too long. Surgery rounds move fast. With 15 to 20 patients on the list, five minutes each doesn't work. Cut it down.
Not looking at the wound. Look at the incision every day. Note whether it's clean, dry, and intact, and if there are drains, note the output and what it looks like.
Skipping the I/Os. They matter in surgical patients. Know the numbers.
Not going to the OR. If you can scrub in, do it. Surgery attendings notice the students who show up and stay engaged in the OR.
Best of luck!
Mike
Disclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content above 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.