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Focus on the anatomy. If you can identify the ureter and major vessels, you'll probably be fine. No one's (hopefully) going to ask you what layers they're cutting though, etc. I would assume you are unlikely to be pimped during the harvest, but maybe the transplant.
A very general understanding of the process of harvesting (how death is declared, what meds are given when and why, graft preservation, etc) will help you understand what is going on.
A very general understanding of the process of harvesting (how death is declared, what meds are given when and why, graft preservation, etc) will help you understand what is going on.
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Are you credentialed to be in his particular hospital? Are you/will you be scrub trained?
Just FYI, the accepted terminology now is "recovering" or "procuring." The term "harvesting" is considered outdated/dehumanizing by a lot of people in transplant but that doesn't mean it's not still used by people who have been trained to use it in the past.
It's really highly unlikely anything will be expected of you as an M1. At most you would be asked about the anatomy as mentioned. Not counting years in practice he has a decade of training over you and he is likely not oblivious to that fact
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Reading up on the procedure and the relevant anatomy is fine, but it's tough to understand and apply that information when you don't have the knowledge/experience to get the big picture. Even M3s and M4s look dumb lol. Heck, even residents and other attendings! You're an M1, you're not supposed to know everything the first time you do something. I would expect that if you're allowed to scrub in, someone will walk you through exactly what to do. The scrub tech is the boss on this stuff - you can always let them know that this is a new experience for you and you need some direction. They'll appreciate that you're trying your best to respect their OR.
The biggest thing that will help you look good is knowing your place in the OR.
- Recognize that a med student, particularly for their first time in the OR, is often a disruption - especially if you scrub in - and is always the least important person in the room in terms of patient care. I say this not as a put-down or to excuse bad behavior, but just as an explanation of what to expect. Your learning is important but patient care comes first. Often if you're getting yelled at or corrected, it's because something needs to be changed to improve the care being provided to the patient.
- Be polite to the scrub nurse and scrub tech - Introducing yourself + "I'm a first year med student and this is my first time in the OR. I'm sorry to add one more thing to your plate, but please don't hesitate to let me know if there's something I should be doing differently" will go a LONG way. It shows that you're interested in participating but also respecting the space and patient safety. If the nurse and scrub tech like you, they'll give you hints on what to do to be helpful and look good.
- Always ask before you do something, touch something, etc. until you get the hang of things.
- It's okay to ask questions and participate, but read the room. If people were idly chatting and then suddenly stop, if people's voices or body language seem tense, if people are talking about what's being done to the patient, probably not a great time to ask questions.
Bottom line...when it comes time for your residency apps, people probably won't remember what you knew. They WILL remember how you acted.
This sounds like an awesome opportunity, enjoy 🙂
The biggest thing that will help you look good is knowing your place in the OR.
- Recognize that a med student, particularly for their first time in the OR, is often a disruption - especially if you scrub in - and is always the least important person in the room in terms of patient care. I say this not as a put-down or to excuse bad behavior, but just as an explanation of what to expect. Your learning is important but patient care comes first. Often if you're getting yelled at or corrected, it's because something needs to be changed to improve the care being provided to the patient.
- Be polite to the scrub nurse and scrub tech - Introducing yourself + "I'm a first year med student and this is my first time in the OR. I'm sorry to add one more thing to your plate, but please don't hesitate to let me know if there's something I should be doing differently" will go a LONG way. It shows that you're interested in participating but also respecting the space and patient safety. If the nurse and scrub tech like you, they'll give you hints on what to do to be helpful and look good.
- Always ask before you do something, touch something, etc. until you get the hang of things.
- It's okay to ask questions and participate, but read the room. If people were idly chatting and then suddenly stop, if people's voices or body language seem tense, if people are talking about what's being done to the patient, probably not a great time to ask questions.
Bottom line...when it comes time for your residency apps, people probably won't remember what you knew. They WILL remember how you acted.
This sounds like an awesome opportunity, enjoy 🙂
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Many hospitals will not let you be at the table unless you're scrub trained so you should find out how to go about doing that on the off chance that he'll let you actually do something.
As mentioned by others, it's very unlikely that your mentor will expect you to know much regarding the procedure or even more than just basic anatomy. Some general tips:
- Know your glove size
- Know the patient's medical history
- Introduce yourself to the scrub tech/nurse and the circulator prior to the procedure
- Don't touch anything!
- Speak only when spoken to
- Don't be insulted when a tech/nurse yells at you
- Do as you're told
A
afib123
Good tips here.
It is very surgeon dependent. You have to gauge the mood. But it's a different environment than wards or clinic where everyone wants you to speak up, be curious, and participate in patient care as much as possible. In the OR, the environment is different till you get used it which likely won't be till you are a resident or become very close to the attending. I would say making small talk is better than trying to ask obscure questions or trying to look smart. Maybe few questions to look interested but nothing excessive.
If they let you scrub, depending on quick of a learner you are, that will be the trickiest adjustment in the first few surgeries. You are bound to look stupid when scrubbing in the first few times. Just try to stay calm, watch lots of youtube videos before scrubbing in. Once you get a hang of it, it's extremely easy. Just takes a few tries to become comfortable
It is very surgeon dependent. You have to gauge the mood. But it's a different environment than wards or clinic where everyone wants you to speak up, be curious, and participate in patient care as much as possible. In the OR, the environment is different till you get used it which likely won't be till you are a resident or become very close to the attending. I would say making small talk is better than trying to ask obscure questions or trying to look smart. Maybe few questions to look interested but nothing excessive.
If they let you scrub, depending on quick of a learner you are, that will be the trickiest adjustment in the first few surgeries. You are bound to look stupid when scrubbing in the first few times. Just try to stay calm, watch lots of youtube videos before scrubbing in. Once you get a hang of it, it's extremely easy. Just takes a few tries to become comfortable
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To add, for general OR advice (to repeat what others have said)
-arrive EARLY, ask someone to help you get shoe covers/cap/mask/whatever you need to get to OR
-ask the staff setting up to help you scrub in because you've never done it. You might get glared at, but they'll help you scrub and gown. Ideally, you will scrub well before the surgery and can re-scrub with that gel stuff (forget the name) when you gown. Also, introduce yourself to the patient in pre-op before you gown.
-stay as far away from the instrument trays as you humanly can. If you are within arm's reach someone will yell at you. I recommend clasping your hands in front of you to keep them above waist.
-once things get moving, do exactly as you're told and ask where to stand.
You'll be nervous but once the knife hits the skin, everything will go smoothly.
-arrive EARLY, ask someone to help you get shoe covers/cap/mask/whatever you need to get to OR
-ask the staff setting up to help you scrub in because you've never done it. You might get glared at, but they'll help you scrub and gown. Ideally, you will scrub well before the surgery and can re-scrub with that gel stuff (forget the name) when you gown. Also, introduce yourself to the patient in pre-op before you gown.
-stay as far away from the instrument trays as you humanly can. If you are within arm's reach someone will yell at you. I recommend clasping your hands in front of you to keep them above waist.
-once things get moving, do exactly as you're told and ask where to stand.
You'll be nervous but once the knife hits the skin, everything will go smoothly.
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I did this exact thing with my mentor who’s a transplant surgeon a few times. Obviously it but here’s some tips in no particular order:
Anatomy: organ procurements are an AMAZING opportunity to see the human body in a way you almost never will outside an anatomy lab. Watch some Acland Anatomy videos before hand so you have some idea of the major structures, vessels, organs, landmarks, etc.
Behavior: don’t be annoying. Try not to force or start conversation in the OR or otherwise. If the surgeon wants to chat he’ll chat, otherwise just be quiet and watch the process.
OR: have you scrubbed before? My first procurement I broke such 3 times by mistake and entered the room without a mask. It was a dumpster fire. Be very careful with the sterile field, maybe watch a few YouTube videos on how to scrub and stay sterile in the OR.
Enjoy it: your mentor doesn’t expect much. He’s inviting you because transplant surgeons love and live for their work. They’re some of the most passionate doctors I’ve met in the hospital. If they see you’re really interested and not just sucking up, that’s noticeable and goes a long way.
Have fun! Procurements are some of the coolest surgeries in medicine.
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Read up on transplant immunology and anti-rejection drugs.
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WTF at some of these suggestions.
Dude you're going to be a M1 going to a procurement. Procurements are generally FAST operations done immediately after the patient officially dies where people are trying to get organs out ASAP and minimize ischemia time in the patient, and cold ischemia time outside the patient.
I would not offer to scrub in on it because you will only get in the way, and during procurement is not the time to be dilly-dallying.
I'd know the patient's history, try to know what organs are likely to be 'good' in the patient (MI x 3 with CAD and CABG x 4 is likely not a good heart transplant donor candidate, for example), but focus on whatever YOUR surgeon is there to procure. Liver? Kidney? Heart? Lung? Know the anatomy of THAT organ as best as you can.
Again, you are a M1, and your knowledge level expectation is extremely low. There is almost nothing you can say that will make an attending think you are a stupid person (just another M1). Don't mess up the sterile field, try to stay out of the way, don't be annoying.
Transplant is a very, very complex field both from a surgical and medical standpoint, and putting extra pressure on yourself to 'perform' as a MS1 is silly, IMO. Instead, be in the moment of the procurement and enjoy the experience that 99% of medical students who are not transplant surgeons (with the rare general surgery medical student or resident) will not have the ability to experience.
Dude you're going to be a M1 going to a procurement. Procurements are generally FAST operations done immediately after the patient officially dies where people are trying to get organs out ASAP and minimize ischemia time in the patient, and cold ischemia time outside the patient.
I would not offer to scrub in on it because you will only get in the way, and during procurement is not the time to be dilly-dallying.
I'd know the patient's history, try to know what organs are likely to be 'good' in the patient (MI x 3 with CAD and CABG x 4 is likely not a good heart transplant donor candidate, for example), but focus on whatever YOUR surgeon is there to procure. Liver? Kidney? Heart? Lung? Know the anatomy of THAT organ as best as you can.
Again, you are a M1, and your knowledge level expectation is extremely low. There is almost nothing you can say that will make an attending think you are a stupid person (just another M1). Don't mess up the sterile field, try to stay out of the way, don't be annoying.
Transplant is a very, very complex field both from a surgical and medical standpoint, and putting extra pressure on yourself to 'perform' as a MS1 is silly, IMO. Instead, be in the moment of the procurement and enjoy the experience that 99% of medical students who are not transplant surgeons (with the rare general surgery medical student or resident) will not have the ability to experience.
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