In Part 2 of ‘Surviving and Thriving in your Surgical Rotations’, Dr Rewa Keegan, gives her tips on how to get the most out of working In the Operating Theatres.
1. Rules of the game
Always stay at the scrub sink for longer than anyone senior to you (this is one of those “unwritten rules” of surgery!). Make sure you know how to glove and gown BEFORE your first theatre case (the wonderful Theatre Educators and CNC’s will help you with this). If you think you will need to scrub out ahead of the case completion, let the team know early on so that appropriate assistance can be arranged. NEVER take an instrument from the scrub nurse’s trolley without asking (this will prove fatal!). NEVER take an instrument that someone else has asked for. ALWAYS pay attention to what you are holding/retracting/the surgical field in general. If you think you have compromised your sterility or the sterility of the operative field, notify someone immediately and scrub out. If a nurse tells you that you have compromised your sterility and you think she is wrong – DO NOT ARGUE. Just smile politely, apologise and rescrub.
2. What to wear
Comfortable shoes: If you are thinking a surgical career is the one for you then invest in some theatre shoes early in the game. My favourite brands are Calzuro’s and Birkenstocks. (Trust me when I say high heels are not appropriate surgical footwear!)
Theatre Hat: disposable theatre hats are available in all operating theatres. I find they make my head itchy and I prefer to wear my own cotton scrub hats. If you are planning a career in surgery it might be worth investing in some of your own comfortable hats.
3. What to do (non operative)
Go and say hi to the patient in the anaesthetic bay if you can. This is a great time to examine patients pre-operatively (feel their hernias and tumours and look at their lesions and pathology) and also nice for the patient as it is a distraction and puts their mind at ease.
Check whether the patient has imaging. If they do, then take the films into theatre and display them on the light-box so they can be referenced by your seniors. Make sure films are returned to the patient! (unless they need to be kept for MDT or further review).
Consider what might be special about the current patient. Does the patient need special surgical equipment/implants or prostheses/sutures/medication? -> If so then check with the nursing and anaesthetic staff that they are aware and organised. Draw up any drugs that may need to be given pre-operatively (e.g. patent blue dye for sentinel node biopsies). Does the patient need to be positioned in a certain way? If so check that beanbags or arm-boards, hand tables or stirrups etc are available.
4. Complete the pathology forms and any other requests
Histopathology, microbiology, tumour banking, consent for research all need to be completed. Does the patient need intraoperative imaging? If so then make sure there is an online or paper request form and the radiographer has been contacted.
5. Post-operative management
Are the patient’s routine medications charted? Does the patient need post-op thromboprophylaxis and is it charted? Is the patient a day-only case who needs follow up arranged and outpatient scripts for analgesia and antibiotics?
6. Being an all-round good intern
If your day is quiet and your team doesn’t need you to scrub you will win MANY friends by offering to go on a coffee or lunch run for your team. You have no idea how much this is appreciated by your hungry, sleep deprived seniors.
7. What to do (operative):
The quality of the surgical assistant can really make or break a case. Come to theatre fed, watered and toileted so you are ready to scrub without delay. Make sure someone is holding your pager and your team/home ward knows how to contact you. Theatre nurses HATE answering phones and pages, and are likely to ignore yours. Let your home ward know you are going to theatre, let them know when you will return, and give them the direct number of the theatre to call FOR EMERGENCIES, and get them to write a list of non-urgent tasks for you to address on your return. Make sure you DO NOT scrub with your pager still on you!
The best way to be a good assistant is to be a prepared assistant who knows what to do and can anticipate the next steps. Read up on any operations you are scheduled to attend and get a feel for the sequence of events. Try and learn some of the anatomy pre-operatively so you get something out of it! (and can answer some questions and impress your boss). Ask where you should stand and how you can help. You can ask for directions at any time if you are not sure what to do. If you can’t see, ask the scout nurse for a standing stool. Make sure you are not obscuring the field of view of the primary operator. Help if you can by adjusting the light or adjusting your retractors (but check with the operating surgeon first). It is all about EXPOSURE and the easier you make it for your colleague to see, the more efficiently the operation will progress.
You may ask for instruments if you know their name and think they will help you, but NEVER take an instrument without asking!
8. Try to get involved
Your first job (aside from retracting) will likely be cutting sutures: keep you hand steady, hold the instrument correctly, ask how long they should be cut. Ask your registrar if you can close the wound (if you feel confident with suturing). If you are more experienced, you may be able to make incisions, practice hand ties, suturing and other skills. Relish every opportunity you are given and try your best – you will shake and feel nervous and clumsy but this will only improve with continued practice.
I hope you find these tips for surviving your surgical rotations useful. And remember that before anything else, preparation is the key to success!