How do you nudge attendings into letting you do more in the OR?

[BananaSplit]

Recently, I've had several discussions with residents within my program and at other programs about attendings who never seem to let you do any actual operating in the OR. Let's say that you're prepared for a case: you know the patient history and diagnostics and indications, have watched videos of the case, know the critical steps and relevant anatomy and you come into the operating room and end up retracting or driving the camera for three hours. I'm sure we've all been there at some point.

How do you nudge these attendings into letting you actually do part or the majority of the case?

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[Dr.LeoSpaceman]

Recently, I've had several discussions with residents within my program and at other programs about attendings who never seem to let you do any actual operating in the OR. Let's say that you're prepared for a case: you know the patient history and diagnostics and indications, have watched videos of the case, know the critical steps and relevant anatomy and you come into the operating room and end up retracting or driving the camera for three hours. I'm sure we've all been there at some point.

How do you nudge these attendings into letting you actually do part or the majority of the case?

If I've operated with the attending a fair amount (especially if we've done similar cases together), I'll just straight up ask. I've also become better at taking more initiative in certain circumstances. If you know the next step, then show them by calling for the instrument, etc. That has been the hardest part--moving from the passive observer to active participant. And really, even if you're just retracting or driving camera, there are those opportunities.

But again, I think those are more bold moves that require the attending to have some amount of trust that you're competent/safe.

 

[neusu]

Just contaminate them, then go to town and get as much done while they are rescrubbing.

 

[filter07]

Ask them sarcastically if they're going to do the whole thing again.

 

[SLUser11]

Recently, I've had several discussions with residents within my program and at other programs about attendings who never seem to let you do any actual operating in the OR. Let's say that you're prepared for a case: you know the patient history and diagnostics and indications, have watched videos of the case, know the critical steps and relevant anatomy and you come into the operating room and end up retracting or driving the camera for three hours. I'm sure we've all been there at some point.

How do you nudge these attendings into letting you actually do part or the majority of the case?

I think you should first talk to the chief residents, and find out what autonomy those same attendings gave to previous residents...it may be possible that they make you watch for a while, then change their approach.

Otherwise, I think it's best to be sincere and direct, and ask the attending if you can do more in the OR. If they say no, you can ask if there's anything you need to do differently in order to be prepared for increased operative responsibility. You can also ask for feedback, and find out if there's anything more that they expect from you than what you're giving them.

As for asking for instruments to show you're anticipating the next move, some attendings actually dislike this, since their huge egos require that it's obvious they are in charge...also, the scrub tech can be confused on who to pass the instrument to if you ask for it, but the attending wants it, etc.

 

[SocialistMD]

Recently, I've had several discussions with residents within my program and at other programs about attendings who never seem to let you do any actual operating in the OR. Let's say that you're prepared for a case: you know the patient history and diagnostics and indications, have watched videos of the case, know the critical steps and relevant anatomy and you come into the operating room and end up retracting or driving the camera for three hours. I'm sure we've all been there at some point.

How do you nudge these attendings into letting you actually do part or the majority of the case?

A lot of times, it isn't the critical steps they want you to know. I have a few attendings who will ask "what's next?" at a certain point. It isn't the next "big" step they want to hear, but the actual next step, however mundane. If you can remember that, they will let you proceed with the case.

 

[blue2000]

When the attending asked for an instrument, I'd just grab it out of the scrubs hands before the attending could.

Seriously -- prepare and ask genuinely.

 

[45408]

"You think I can sew this half of the anastomosis?"

"Mind if I close?"

Or if it's a lap case, just go stand on the operating side, and only move if they ask to switch. Obviously, keep in mind what level you're at and what level the case is...

 

[Buzz Me]

Agreed that it depends on your comfort level with any given attending (and, more importantly, their comfort level with you). Ask other coresidents or your chief which attendings are more likely to give up parts of the case as they learn to trust you.

 

[DrDawg]

What level are you and what are the cases?

In general you need to insert yourself into the case or cases. (This may take a couple of cases if you are unfamilar with each other.) If there is a bleeding vessel and you are sitting there doing nothing, I'm not going to let you do anything the rest of the case. As a resident I always asked for instruments, if the attending ask before me I would grab it myself if he/she didn't immediately reach for it. Ask questions that demonstrate you have read ie "do you like to do your GJ anitperistaltic or peristaltic". So what if they do the major part, do a good job with the assisting, and the next case maybe yours. If all else fails, try to get a chief resident to operate with you. They maybe willing to give you more feedback about where your skills are at.

 

[doc05]

How do you nudge these attendings into letting you actually do part or the majority of the case?

You can't. All of this is attending-dependent. Some will let you operate; some won't. Learn who to avoid.

Good luck.

 

[Jwax]

The best story I just heard recent was a resident literally just stood right in the way of the attending for the emergency thoracotomy. He also moved the instruments out of the attendings reach so they really couldn't do anything. Ballsy? Brilliant?

I just take the same approach I took as a med student, the worst answer you can get to asking if you can do something is "No." (sometimes with condescension and irritation but whatev). So if I think it's something I ought to be able to do, I ask if I can do it. Pays off > 60% of the time. Obviously, I am less likely to ask the people I haven't worked with much to do things so there is a selection bias.

 

[Raygun77]

The best story I just heard recent was a resident literally just stood right in the way of the attending for the emergency thoracotomy. He also moved the instruments out of the attendings reach so they really couldn't do anything. Ballsy? Brilliant?

I just take the same approach I took as a med student, the worst answer you can get to asking if you can do something is "No." (sometimes with condescension and irritation but whatev). So if I think it's something I ought to be able to do, I ask if I can do it. Pays off > 60% of the time. Obviously, I am less likely to ask the people I haven't worked with much to do things so there is a selection bias.

Brilliant! Did the patient die when he/she prevented the responsible doctor the opportunity to take the necessary steps? Must have been great learning!

 

[Winged Scapula]

Brilliant! Did the patient die when he/she prevented the responsible doctor the opportunity to take the necessary steps? Must have been great learning!

You must have missed the descriptor: "emergency thoracotomy".

Its unlikely that the patient would have survived regardless of whom was wielding the knife.

 

[ele190]

Wow...it's really the promise land in Italy residents mostly must stand where they are and do just what they're told to, asking to do more is seen as a major insubordination and no one would ever DARE asking for an instrument which is not a retractor. Attendings who pass on surgeries or part of them to residents or junior attendings are about the 1% (and i was very lucky to have one of them as my menthor!)
Once i was brave enough to ask for the suction stuff to the tech and he yelled at me

 

[SouthSideSteve]

.

 

[Buzz Me]

Wow...it's really the promise land in Italy residents mostly must stand where they are and do just what they're told to, asking to do more is seen as a major insubordination and no one would ever DARE asking for an instrument which is not a retractor. Attendings who pass on surgeries or part of them to residents or junior attendings are about the 1% (and i was very lucky to have one of them as my menthor!)
Once i was brave enough to ask for the suction stuff to the tech and he yelled at me

That is just so sad.

 

[ele190]

I was very lucky because in my fourth year of university i found myself in a non-university department in the mandatory rotations and met my menthor which is a very good person and surgeon: i stayed there for the past 3 years and half (fortunately we can almost avoid mandatory rotations which consist in following the attendings and residents in silence while they act like you're not even there) and he raised me up, surgically and humanly. He made me grow up with an open mind and, when he could, he made me help him in the OR and allowed me to think with my own brain and speak my mind: now he trusts me and always listen carefully to my suggestions, even if i'm just a 25 year-old brat and he's a 63 year-old senior attending.
I saw many residents who grew up in university places and they're just used to obey attendings and senior residents, they never speak their mind and in the OR are extremely passive. I'm scared now because if i start my residency i will have to work in those places and it feels like i'm gonna waist my time. What's the future of medicine if young surgeons are raised like this??