As an anesthesiologist, I have a front-row seat to loads of medical students rotating through the OR on their surgical rotations.
Some students know just what to do. They’re helpful, effective, and it’s plain to see how they’re extracting all that they can from their surgical rotation.
Other students look like deer in the headlights, unsure of how to behave, where to stand, and how to conduct themselves in a high-stakes professional setting. Still, others think that they’re “crushing it,” but an outside observer can clearly see they’re trying too hard to impress—and missing out on valuable learning opportunities as a result.
Needless to say, you want to be in that first camp: helpful, ready to learn, and understanding your role. If you’re unsure how to go about doing that, we can help. In this article, we’re going to reveal some hidden skills that can help you shine under the bright lights of the OR instead of freezing like a deer.
Here’s some tips on how to excel during your surgery rotation.
How to Shine in the OR as a Medical Student
1. Focus intently on how procedures are done.
There’s much to learn in the OR as a medical student. But one of the main reasons you’re there is to acquire certain procedural skills. And how do you get better at the procedures you’re there to learn? It may sound obvious, but it’s through focusing completely on what you’re being taught. I don’t mean merely paying attention. I mean focusing on every detail of what is happening.
For example, I can still hear the words the surgical fellow said to me when I was on my surgery rotation. As we were closing an abdominal gun shot wound at 6 a.m. post-call, he said “Watch exactly what I’m doing. That’s what you’re going to do.”
The moment illustrated a key point: when you’re in the OR, it’s important to note in minute detail how procedures are done. How do they hold the scalpel? Where and how do they attach the Bookwalter retractor? How hard do they pull on the Army-Navy? Where do they grip the needle with the needle drivers? How often and where are they suctioning?
You can learn so much without saying a single word. You have a fantastic view of everything happening, and even if it’s your turn to stand there with your hands on the drapes, pick up everything you can through dedicated observation.
2. Be a receptive listener.
One of my pet peeves from teaching residents in the OR was when I would try and teach a concept, and the learner would feel so compelled to demonstrate how deep their fund of knowledge was, that they had to finish my sentence.
Yes, that’s great, good for you that you know this fact. But how did you know that’s where I was going with this? Maybe I was about to say something completely different.
Example:
Me: “When you’re placing the IV, after you get the flash of blood…”
MS4: “…you have to advance the needle a little more before advancing the catheter. I know.”
Okay, while that’s true, how can you be sure that’s what I was going to say? Maybe I was going to tell you to pause, and let the vessel refill with blood. Or I was going to give you the precise measurement of how much catheter lies outside the needle based on the size of the cannula you chose. Or perhaps, how this is different from blood traveling up an arterial line set up.
When someone is teaching you something, there’s no need to finish their sentences. Be a receptive listener. You’ll have many other ways and opportunities to demonstrate how much you truly know.
3. Know your surgical case and patient inside and out.
You’ve got a 73-year-old man for a carotid endarterectomy. It’s your responsibility to know his medical history and his current presentation. How long ago did he go to the clinic? What did his imaging show? Any comorbidities to keep in mind? What are his lab values? How is his echo? Stress test? Does he have an active type and screen? Does he need one?
But not only must you know everything about the patient, you must have total knowledge of the procedure. For a carotid endarterectomy, what are the steps in the procedure? What are the indications and landmark studies that helped develop the surgical criteria? What is the anesthesia plan? What other anesthetics can be used for the procedure? Will there be fluid shifts? Pain control issues? Are there critical portions of the procedure? What are the complications and how often do they come about?
In addition to shining in front of your residents and attending, cementing the knowledge through real patient experiences will pay true dividends for shelf exams and USMLE exams thereafter. Go deep!
4. Maintain situational awareness.
Situational awareness in the OR means understanding the big picture and how you fit into it. It means knowing your abilities and limits. It’s knowing not to ask non-urgent questions during catastrophes (i.e., inquiring about colleagues’ weekend plans when the surgeon accidentally nicked the IVC). It’s about being as helpful as possible to those around you.
This could mean pushing a bed out of the room, getting sterile gloves for your residents, offering a hand to hold during anesthesia induction, or holding pressure on a missed IV/A-line. Always pay attention instead of letting your mind wander. Predict the next step, and decide if you can be instrumental in its completion.
Situational awareness seems to be a skill that some students have, and some students lack. If you seem to have trouble with it, don’t despair. It can certainly be taught and improved with dogged effort.
5. Introduce yourself, and be polite to everyone.
I’m definitely sympathetic to the plight of the medical student. You’re neither here nor there, you know how to do some things, and not others. And underneath it all, you aren’t sure what you’re allowed to do. You might even find yourself just sort of standing in the way, especially in a crowded OR with lots of staff moving around the room.
What you can do is make sure everyone in the room knows who you are. And not in the way that you need to prove yourself to patients and wear the moniker of a “student doctor.” Simply state your name and what you’re doing there (i.e.,“My name’s Jim, I’m a medical student on my general surgery rotation”—or, even better, here’s a guide for introducing yourself to patients for an exact script).
Now you have a place and a role. When people know who you are, you’re no longer in the way, you’ve defined your reason for being there. You might even be tasked with something useful to contribute. But when you stand there and people don’t know who you are, you’re simply in the way.
Make a confident introduction to everyone, from the surgical attending to the patient care techs cleaning the room between cases. Good manners and politeness get noticed by everyone.
6. It’s okay to say, “I don’t know.”
Medical students dig themselves into a hole (that can be hard to claw out of) when they act like they know the answer to a question. If you have a decent idea or have it narrowed down to two choices, sure, take a stab at it. But if you’re standing in that carotid surgery and you get asked, “What’s the first muscle to get transected,” if you’re clueless, simply say you don’t know.
Once you start rattling off nonsense (e.g., ummm…the ocularis?), you might be asked questions about that and further demonstrate your lack of preparation. Your best bet? Know the answers to the questions you know you’ll be asked!
Short of that, plead ignorance and confidently say that you don’t know. This sets you up to be a receptive learner of the answer, instead of a defender of the incorrect.
7. Never disappear.
As a medical student you have to walk a lot of fine lines. You have to be eager without being over eager. You have to be helpful but not overbearing. And you have to educate patients but still stay within the confines of your knowledge.
Another important line to walk is be available and helpful, but don’t be a shadow to your resident or intern. When something comes up in the OR, like a patient in the ED who needs to be seen, you might be sent on an information gathering mission. While your team in the OR waits for your report on the ED patient, another resident might pull you aside to help with a dressing change. You finish the dressing change, but leave your patient list full of PHI down in the ED. Now your OR team is wondering why you’ve been gone for 45 minutes to do a 15-minute job.
Whenever you’re counted on to be somewhere or do something, check in immediately after the task is completed. In this scenario, the med student should call into the OR and let them know, “I can tell you about Mr. Jones in the ED, but Julie needs a set of hands for a dressing change.” Your primary team there will decide what’s more important for you. In other words, deliberate communication is key.
Oftentimes, you’ll be sent off to “go and study/read” when cases are done. If you’ve been at it for a while, check in with your resident to see if you can do anything else. The thing to avoid, both in medical school and throughout your training journey, is disappearing. Don’t leave your team wondering where you are.
8. Remember, it’s not all about you.
Surgical services, as well as operating room teams, are mega-machines with lots of pieces. And while your education is important, you’re not in the center of this universe. Hopefully your mentors and residents are trying to teach you as much as possible, but sometimes you’re going to be a mere accessory in getting the unimaginable amount of work done.
When things aren’t going well in the OR, the gravity of the situation might mean your learning takes a back seat to saving a patient in need. Residents and attendings get stressed too, so you’ll have to understand if they aren’t serving you knowledge on a silver platter and are instead doing damage control.
Stay humble and know your place. If your education is frequently taking a back seat to scut work, that might be an issue worth bringing up with the program director. But oftentimes, scut work is where you learn how to perform like an intern. As long as you’re doing what you can to lighten the loads of those further along in training, and picking up knowledge along the way, you’re doing the right thing.
Final Thoughts
Keep all of this in mind as you try to put your best foot forward and meet the demands of your surgery rotation. It can be a grueling couple of months, but with the right attitude, a willingness to work hard, and the support of those around you, you’ll be sure to shine!
For more (free!) resources to help you through clinical year, check out these other posts:
