The OR is a confusing place for medical students. Your role is vague, you are often ignored, and you will likely not know what is going on at the beginning.
Here are a few tips to ensure you demonstrate the minimal competencies to excel in the operating room as a medical student:
1. Know your patient.
Knowing your patient is not necessarily something that will impress your attendings and residents as you will rarely get the opportunity to showcase how much you know. Rather, knowing your patient is important so that you actually get something out of the OR case. That is, understanding why your patient is there in the first place and what the alternatives were goes a long way in helping you maintain your enthusiasm and energy throughout what can be long, trying cases. Often, you will get a chance to talk to these patients pre- and post-operatively. Don’t pass these opportunities up!
2. Know your anatomy.
This is important because this is where you earn brownie points with your attendings and residents. Attendings and residents love pimping you on basic (and often complex anatomy). In general, you should obviously know where each organ lies relative to other organs and surrounding structure. Beyond this, know arteries, veins, and nerves that frequently need to be navigated around for each organ. Finally, know anatomic variants that can often arise and complicate procedures.
A good example of this is a cholecystectomy: you should know where the gallbladder is in the body, how it sits next to the liver, the critical view of safety (a space formed between the cystic duct and artery), the arteries of the celiac trunk (blood supply), as well as variant hepatic artery anatomy (for bonus points).
3. Anticipate the next step.
Beyond being able to answer questions appropriately, you should be able to anticipate the needs of your team as they operate. This means anything from knowing when they will need a suture cut to knowing when to move out of the way to make room for someone else. Being able to pass equipment as needed (which means you need to know the names of the tools) is helpful but using the equipment is even better.
Knowing when to use the suction (when there is a lot of blood or fluid obstructing a surgeon’s view) can help your team tremendously. Retracting with an understanding of where your team is trying to look is important – you don’t want to be the med student who is retracting aimlessly, only to be redirected by the team whenever they need you to move. These tasks are something that everyone generally struggles with at first but will become intuitive as more time is spent in the OR.
4. Volunteer to help anesthesia.
Even if you are there with the surgery team and are only helping with positioning and prep, anesthesia needs you! One way to truly stand out is to help anesthesia before and after the case, as making their lives easier directly makes your surgery go by faster, and any surgeon can tell you the one thing missing in their lives is time.
5. Practice suturing.
Yes, practice suturing — even if you have no intent on being a surgeon. This is a way for you to demonstrate enthusiasm and is an excellent skill to have in any field you choose to go into. The key to good suturing is to realize you cannot mess it up. Many medical students fall into this trap and end up sticking themselves, taking forever, and doing a sloppy job. Have confidence, practice, and do as you are told. You will be just fine. If you aren’t inclined to suture, at least give it a shot a few times so you don’t seem indifferent. Trust me – your residents are watching.
