Next Level Operating Room Tips

Once you know the basics of how to look comfortable and be helpful in the operating room, it is time to push the envelope. Particularly for students interested in surgical fields, any opportunity to impress an attending or resident should be capitalized on. Once you feel comfortable with the basics, try to incorporate these resident level skills into your routine.

Marking Pen

Always have a marking pen, ruler, and alchohol wipes in your pocket. When attendings walk into the operating room, before prepping they often mark their incision lines on the patient. The attending will state, “Marking pen,” and the circulator is scrambling to get one out of the supply cabinet. To get to the next level, you should have a marking pen, ruler, and alcohol wipes in your scrubs’ pocket, ready to give to the attending. Next time she or he asks for one, they will notice you were prepared.

Gown and Glove Yourself

Learn to gown yourself. Being able to do so is an invaluable skill for the efficiency of the prepping and draping process prior to the first incision. Instead of helping you gown and glove, the scrub can be passing off the drapes, setting up the cautery, and organizing the instruments. No attending enjoys waiting to drape the patient because a medical student is being gowned by the scrub. It may be difficult to gain trust with scrub nurses or scrub techs initially. Most scrubs don’t trust medical students to gown themselves for risk of contamination of the sterile field. Still, it is an important skill to master and will serve you well for the rest of your career.

Suture Scissors

As soon as someone asks for a stitch, after the suture is passed, ask the scrub for suture scissors. Residents do this, and you should too. Almost every stitch that is thrown, will need to be cut after it is tied. Have the scissors ready, and become comfortable using them with both hands. OR scissors are actually made to cut with your right hand, so if you are forced to cut something with your left hand due to the angle, it can be a little tricky. Find a pair and practice using both hands.

Know Your Patients

Study and learn the patients you are operating on. This takes time, but it is helpful preparation for a medical student for a number of reasons. For operative patients, knowing the patient’s medical history helps give you a clearer perspective on the indications for the surgery and the pre- and post-operative management required. You may also be specifically asked details of the patient history in the case by the attending or resident. “Medical student, tell us what we are doing today and why this patient needs it.” I was asked this on my second day in the operating room on my first surgical surface.

My inability to answer the question was not received well, prompting me to review briefly the updated history and physical of the patient before every case after that. I write down the patient’s name, age, sex, co-morbidities, smoking status, prior surgical history, and any other detail that might be relevant to the case or understanding the surgical management of the patient. When the attending generally asks to the room, “Is this patient a smoker?” you can promptly reply, “Former smoker of 1.5 packs/day for 20 years. Patient quit smoking three years ago.” That is next level. That is having an edge. That is being helpful and contributing to patient care. It will be noticed.

Starting out on your surgery clerkship can be daunting. There are so many new things to learn about being in the operating room. Be observant and learn from everyone. Elevate your game to the next level with these tricks.

Are you ready to elevate your helpfulness in the operating room? Master these tips, and you will do well. Comment below.

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Carter J. Boyd, MD, MBA
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