A team of surgeons and staff pull out a cell phone, serving as enough of a distraction to cause a patient death during an otherwise routine appendectomy.
A surgical resident wakes up after a one-night stand with a man who we later find out is her new attending.
‘Alcohol + Surgery = No No’ is scrawled across a whiteboard as two new doctors contemplate when their orientation will start to cover “patient care”.
These are some of the iconic introductory scenes to some of the juiciest surgical shows on television. Okay—maybe ‘available for online streaming’ is a more accurate descriptor for our cord-cutting, time-pressed generation. But nevertheless, when it comes to appropriate behavior during surgery there can be some serious faux pas. So here are some of my top tips for observing in the OR so you can step it up each and every time you step into surgery.
What to wear: Very casual business casual
I recommend arriving in something that is on the more casual side of business-casual. While I’m generally pro “dress for success”, it’s certainly not a requirement for your day of observation as you will soon be changing into scrubs. Another staff member working for the hospital or surgery center will typically greet you when you first arrive before showing you where to pick out your scrubs and a locker room where you can change and store your personal items.
What to bring: Sneak in your sneakers among other things.
It’s important to stay as comfortable as possible. You’ll most likely be standing for a few hours or jumping alongside the surgeon from operating room to operating room. Be sure to bring some comfortable shoes with you so you can keep up. It’s also a good idea to bring an identification badge. Not all observation sites will require it, but it can be helpful to the staff to better recognize you as a new face in the workplace. A jolly rancher, gum, or mint can sometimes help to keep you from feeling woozy. If you ever do feel lightheaded be sure to let the support staff know as soon as possible and ask them to assist you in either exiting the room or finding a seated position.
What to do: Be respectful—not a distraction.
It’s important to understand how your presence in the exam room can affect the surgeons and staff. Some rooms are smaller than others, making it extremely important that you are aware of your body language and the space you occupy. There is a general code of conduct that exists in the OR: never touch anything that is blue! The blue covers and sheets mean that the area is sterile. Touching it could contaminate it and thereby slow down the entire operation.
When asking questions, be sure to do so at the appropriate time. Depending on the surgeon, they may take a moment to elaborate on the procedure as a teaching moment. The appropriate response to this may only require a simple “Mhmm”, “Okay”, “Right”, or “I see”. If questions are posed, answer appropriately but leave longer discussions and questions for when the surgeon is between patients and can better hear you and address your thoughts and discussions. Remember: this is the patient’s surgery and their time and the attention they receive while on the operating table take priority!
What to expect: Be prepared for a long, or short day!
I’ve spent time observing with 2 cataract surgeons, 2 refractive error surgeons, 1 oculoplastic surgeon, and 4 retinal surgeons. On one observation opportunity, I was in the OR for 8 hours! On another, a mere 4 hours coupled with the remark, “If you’ve seen one cataract surgery, you’ve seen them all!”. There can be a gray area when it comes to how long you’re expected to stay and who makes that deciding factor.
My advice would be this: for opportunities that you have set up for yourself (as in, you are requesting to shadow but it is not an expectation or requirement) ask the surgeon/ coordinator, “May I observe a portion of your surgeries – either in the morning or the afternoon?”. Requesting a half-day of surgery gives you an adequate amount of time to learn without seeming like an imposition to the surgeon and staff’s schedule.
For opportunities that are set up for you, stay until you are dismissed or until the shift comes to a natural end or hiatus. In this situation, you may get the feeling that it’s “up to the surgeon to decide”—which really means they’re willing to teach for as long as you’re willing to be there. Don’t be the person that skips out early, unless a staff member or the surgeon brings it up to you first. If a surgeon has granted you their time and attention to teach you be respectful of that and use that time to learn.
Observing is an amazing way to learn more about the profession we all engage in. Retinal surgeon Dr. John Kitchens, MD of the Retina Associates of Kentucky once spoke to me about the importance of observing, addressing both the MD and the OD perspective. He iterated that the optometrist’s decision to refer to one surgeon over another, is a decision they make about the patient’s outcome. While we may not be the ones performing the surgery, we certainly have a valuable role to play. With these tips in mind on your observation day, you’ll be able to focus on learning and taking in everything the experience has to offer.