1. Show up on time to the procedure. It’s awkward introducing yourself in the middle of the procedure while the surgeon’s head is down and is intensely operating.
2. Find out the type of procedure before attending it by checking the OR schedule. Read the patient’s H&P so you know why they are getting the procedure. Ask the attending if you may be present for the procedure and if you should scrub in. If scrubbed in, you have a chance to assist the surgeon. Ask someone (student, scrub tech, nurse, doctor) how to scrub in if you don’t know how, and then practice. This is important because if you touch something that is sterile when you are non-sterile, then the whole procedure must be shut down. So, avoid the blue area. Don’t fret if you are not scrubbed in, because it may not be necessary. For example, a robotic surgery or a laparoscopic surgery is best viewed on the monitor.
3. Learn the relevant anatomy of the procedure. Focus on organs, arteries, veins and nerves. Understand normal anatomy and don’t worry about rare abnormalities. Clinical correlates are also important to know. For example, know that nicking the recurrent laryngeal nerve during a thyroidectomy results in voice hoarseness.
4. Know what the overall procedure involves, but don’t concern yourself with detailed steps. Know the big picture.
5. Eat before the procedure and plan out your meals. If you are going into a 10 hour cardiothoracic case, then eat a big breakfast. No one likes a malnourished and dehydrated med student fainting in the middle of the case.
6. Learn about the patient’s symptoms by talking with them either on the day of the procedure (but before anesthesiology comes and sedates the patient) or on the previous day. This will solidify your learning. For example, it will make sense why someone with a esophageal hiatal hernia gets a Nissen fundoplication because the patient has unresolving chest pain and a feeling of food stuck in their esophagus.
7. Introduce yourself to the people in the OR. Let the charge nurse know because you must be documented as being on the case. Write your name on the whiteboard.
8. Show enthusiasm and interest during the case. Take opportunities that you may never have again. For example, hold the uterus after it is removed in a hysterectomy to see how thick the myometrium feels. Practice knot tying and suturing and the surgeon may let you close after the procedure. If you don’t know how, ask for help.
Hopefully, following this guide will make the OR a fun learning experience that you will never forget.