I F'ed up

[FutureCTDoc]

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I have yet to see a med student wear loupes. Loupes are expensive, and heavy, and there's no real need for med students to wear them. (They're not doing the operation, after all!) I've always wanted to, just so I can see what the attending and resident see, but oh well.

I do have my own set of loupes, which were my father's, he is in ophtho where the operating microscope is used now instead of loupes, loupes aren't that great owing to the fixed focal length meaning they're set a permanent distance, in my case 18 inches, I plan to use them for my MS-III surg clerkship. I plan to keep them out of the patient though.

 

[nope80]

I haven't started OB yet but when we had orientation they took us to the OR and the nurses spoke about scrubbing in, surgical field, etc and I was completely overwhelmed by the whole "surgical field" what to touch, what not to touch etc. Especially with putting gloves on, the manner in which you can grab things, it was SOOO confusing!!! Anyone care to share some simplified tips on what not to do or things that are obviously wrong (other than reaching into the abdomen to feel the patients liver with a bare hand🙂 )

 

[psychforme]

I haven't started OB yet but when we had orientation they took us to the OR and the nurses spoke about scrubbing in, surgical field, etc and I was completely overwhelmed by the whole "surgical field" what to touch, what not to touch etc. Especially with putting gloves on, the manner in which you can grab things, it was SOOO confusing!!! Anyone care to share some simplified tips on what not to do or things that are obviously wrong (other than reaching into the abdomen to feel the patients liver with a bare hand🙂 )

you sure you want advice from people in this thread 😕

 

[smq123]

I haven't started OB yet but when we had orientation they took us to the OR and the nurses spoke about scrubbing in, surgical field, etc and I was completely overwhelmed by the whole "surgical field" what to touch, what not to touch etc. Especially with putting gloves on, the manner in which you can grab things, it was SOOO confusing!!! Anyone care to share some simplified tips on what not to do or things that are obviously wrong (other than reaching into the abdomen to feel the patients liver with a bare hand🙂 )

If it's on blue, it's not for you (so don't touch it with your bare hands).

In other words, if it's on a blue piece of cloth, it's probably sterile. So don't touch it when you're not scrubbed, gowned, and gloved!! (In some places, they use green surgical drapes, but the idea is still the same.)

If in doubt, ask, "Is this sterile?" That's better than finding out the hard way....

And if you're itchy, remember that you're scrubbed in. So you can no longer just reach over and scratch where ever it itches. That was one of the biggest things I had to remember.

 

[smq123]

I do have my own set of loupes, which were my father's, he is in ophtho where the operating microscope is used now instead of loupes, loupes aren't that great owing to the fixed focal length meaning they're set a permanent distance, in my case 18 inches, I plan to use them for my MS-III surg clerkship. I plan to keep them out of the patient though.

😱 I would definitely not wear them to your MS3 surgical clerkship. You will endure unbearable teasing from your fellow students, the residents will look unfavorably upon you because it looks like you're being arrogant and presumptuous ("Who does he think he is?"), and your attendings will think that you're a dork.

Don't wear them. I would venture that if you insist on wearing them throughout the clerkship, they may even negatively comment on it on your evaluations.

This goes for all med schools, MD or DO. The surgery hierarchy is the same everywhere.

 

[Doctor Bagel]

😱 I would definitely not wear them to your MS3 surgical clerkship. You will endure unbearable teasing from your fellow students, the residents will look unfavorably upon you because it looks like you're being arrogant and presumptuous ("Who does he think he is?"), and your attendings will think that you're a dork.

Don't wear them. I would venture that if you insist on wearing them throughout the clerkship, they may even negatively comment on it on your evaluations.

This goes for all med schools, MD or DO. The surgery hierarchy is the same everywhere.

Agree. I'd also say don't wear specific surgical goggles or your own hat as a student. Go with the disposables provided at the hospital.

 

[RxnMan]

...loupes aren't that great owing to the fixed focal length meaning they're set a permanent distance...

I'll say it's cool you want some tradition, using your dad's stuff, but don't do it. MS3's don't need that equipment. You're just not that important. And we all know what a fixed focal length is.

I haven't started OB yet but when we had orientation they took us to the OR and the nurses spoke about scrubbing in, surgical field, etc and I was completely overwhelmed by the whole "surgical field" what to touch, what not to touch etc...

Know your glove and gown size, get them out for the scrub tech as each case is getting set up. Get scrubbing in down. Don't worry about soap vs. chlorhexidine - just ask and do whatever the attending wants. Say thanks a lot.

Once I scrubbed in, I approached the patient, stopped, and asked the attending where to stand. 90% of the time you will be next to the resident, at the level of the patient's legs. A simple rule to keep yourself out of trouble is to place your hands lightly on the sterile field at the level of the pt's legs and just keep them there until the end of the case or if you are told otherwise. If you're not sure, stand still and hold your hands close to your chest (the sterile field is from the level of your shoulders to your umbilicus).

Avoid handling anything (i.e. passing instruments) until you get the hang of things and understand what each person wants things to run. Watch, ask questions, be interested.

Follow these guidelines, and you will get you through 90% of operations without a problem.

Agree. I'd also say don't wear specific surgical goggles or your own hat as a student. Go with the disposables provided at the hospital.

If you wear glasses, I reccomend using the disposable plastic two-piece eye shields + separate masks that have adhesive for the bridge of the nose. I found that set-up to fog the least. You can also use the all-in-one face shield+mask, but I usually needed to adjust them and use tape to keep the fog down.

Everyone should wear eye-gear - the only times I didn't I always regretted it - i.e. near-misses of splashed fluids.

 

[VMSmith]

Avoid handling anything (i.e. passing instruments) until you get the hang of things and understand what each person wants things to run. Watch, ask questions, be interested.

I think this is one of the biggest things to get used to. Your natural instinct is to want to help out and do something, but until you actually know what's going on you're more likely to get in the way and slow everything down (or worse, do actual harm) than help.

When the attending or resident tells you to put your hand somewhere or hold something, do it. If they tell you you're doing it wrong and take it back from you, apologize, and if they seem in the mood for answering questions, ask how you did it wrong.

Be aware that "right" and "wrong" can be different things for different attendings. So even if you think you're doing something the way you were taught to do it, if an attending tells you you're doing it wrong then you're doing it wrong.

Later on in the clerkship, when you have a basic understanding of operating techniques and the different procedures, AND you understand how the different attendings like to do things in their own ways, THEN you can do some things without anyone asking.

And don't piss off the scrub techs or the nurses. The attendings (and to some degree, senior residents) can get away with it but you cannot. Do what the techs and nurses tell you to do unless an attending or senior says otherwise.

 

[JPmamd09]

I haven't started OB yet but when we had orientation they took us to the OR and the nurses spoke about scrubbing in, surgical field, etc and I was completely overwhelmed by the whole "surgical field" what to touch, what not to touch etc. Especially with putting gloves on, the manner in which you can grab things, it was SOOO confusing!!! Anyone care to share some simplified tips on what not to do or things that are obviously wrong (other than reaching into the abdomen to feel the patients liver with a bare hand🙂 )

I think everyone's given good advice so far. ALWAYS ask if you don't know - ask before you touch, ask before you move, and occasionally (depending on the surgeon's personality and the urgency of the case) ask before you ask a question. By that I mean that questions are not always appropriate or appreciated. Just use your best judgment.

As far as the glove thing, it takes practice. Most of the time (in my experience at least) the surgical tech was already scrubbed in and ready before I was, so he/she typically helped get me gowned and gloved up. The first few times, just let them know that you're a student and new at this and ask for advice/tips/help. Someone mentioned saying "Thanks" a lot; I also started a lot of sentences with, "I'm sorry to bother you, but ..." I think my humility was appreciated. We were also lucky enough to have some scrub techs volunteer to show us how to glove and gown ourselves for deliveries - that was super-helpful because I'm not very good at it, so you could consider asking that.

I think as long as you admit you don't know something, ask for help, and do what you're told to do, you'll ultimately be fine (it's kind of like every other part of med school/medicine I guess). Good luck! Try to enjoy and learn! 🙂

 

[RxnMan]

...Be aware that "right" and "wrong" can be different things for different attendings. So even if you think you're doing something the way you were taught to do it, if an attending tells you you're doing it wrong then you're doing it wrong...

This also hints at the basic premise of third year: the student is always wrong. The bane of your existence as a MS3 is that the moment you become acclimated to a service and you start becoming productive, instead of a drag on the team, you're off to the next rotation. You will always be off balance.

So a big part of things is "yell avoidance," where you do whatever it takes to decrease the amount of reprimanding you recieve. Try to figure out how things work on a service, but don't stress if it doesn't happen after a day - at the beginning of my 3rd year, it took me two weeks to get settled. Now at the end of MS3, I can usually figure out a new service in 3-5 days.

In along with this is giving yourself permission to fail once in awhile. Not doing a perfect H&P is OK. You will get yelled at even if you did things like you were told (see above). Profs almost always give you critisism because they think they're cheating you of an education if they don't. It's OK to be wrong, it's not OK to not try.

 

[VMSmith]

In along with this is giving yourself permission to fail once in awhile. Not doing a perfect H&P is OK. You will get yelled at even if you did things like you were told (see above). Profs almost always give you critisism because they think they're cheating you of an education if they don't. It's OK to be wrong, it's not OK to try.

Yeah, I think the secret to "success" in 3rd year is to realize that in actuality, you're expected to be wrong most of the time. It's the way you respond to being wrong (whether or not you actually were wrong) that determines how well you do in any given rotation.

Don't complain.
Don't protest that you were actually right, even if you were.
Don't make the same mistake over and over again.

Do be interested in your attending's explanation of why you were wrong.
Do go home and read about the topic, and for extra brownie points, do a presentation about it.
Do be ready to accept that despite all this effort, some other attending might tell you something totally different in the future, and make you do all this all over again for the same exact thing.

And as we've seen from the OP, NEVER EVER EVER lie about something in order to avoid criticism. In medicine, dishonesty is perceived as being much worse than incompetence.

 

[sprinkibrio]

Yeah, I think the secret to "success" in 3rd year is to realize that in actuality, you're expected to be wrong most of the time. It's the way you respond to being wrong (whether or not you actually were wrong) that determines how well you do in any given rotation.

Don't complain.
Don't protest that you were actually right, even if you were.
Don't make the same mistake over and over again.

Do be interested in your attending's explanation of why you were wrong.
Do go home and read about the topic, and for extra brownie points, do a presentation about it.
Do be ready to accept that despite all this effort, some other attending might tell you something totally different in the future, and make you do all this all over again for the same exact thing.

And as we've seen from the OP, NEVER EVER EVER lie about something in order to avoid criticism. In medicine, dishonesty is perceived as being much worse than incompetence.

I was just about to write my f'ed up story of "I can't remember the last time I got a pimp question right." Thanks for this post.

 

[Jwax]

"Are you on my side or the disease's side?".

Funny.

Just two weeks into 3rd year so I haven't really f*ed up yet, just stupid mistakes. Like, when trying to get a ~15 mo old kiddo to let me listen to him without crying, I like him hold the stethescope, which he promptly dropped on his head and started bawling (got over it in a minute, so I guess I didn't cause brain damage). Also had a pt at a free clinic that I was seeing before the doc back in 2nd year and was trying to explain long QT syndrome and the possible risks... basically made her think she was going to drop dead at any second and she started to freak out. Had to get the doc in asap. 😳 He soothed her. I'm a little scared to try and explain anything with real potential risks now, though that was a year ago. Also not the biggest f* up ever.

Sounds like the finger pointing daughter saying you sucked the life out of the room wins this thread.