MS-3 talking in the OR

[chicamedica]

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Is it bad to ask questions (or to ask to do procedures) when I'm scrubbed in during a surgery in the OR?

For the former, I always hesitate, b/c I'm never sure if I'd be disrupting intense concentration during a tense/crucial moment. For the latter, I don't want to be presumptuous (and also don't want to likewise interrupt an important moment)

On the other hand, I'm never sure if my silence would be taken to mean I'm unprepared or unenthusiastic.

 

[ckent]

Yes, you should feel free to talk and ask questions in the OR. Your quesitons should not be too ignorant though (ie you shouldn't be pointing at the liver and asking 'what's that?'), and you should be careful at judging whether or not the attending surgeon is ok with you asking questions (some get upset if you ask them something that they don't know). Some attending surgeons will just ignore you in the OR too, but the good ones should want to teach you something. If they want you to be quiet, they will probably tell you to be quiet or it will be obvious (eg blood splattering all over the place with people yelling). Most OR moments are calm though.

 

[madcadaver]

Try asking "Dr. (attending), may I ask a question?"

Pretty self explanatory but needed to be said...

 

[ollaguna]

Torwards the end of the case, questions regarding the post operative management and possible complications, in my limited experience, have been well regarded and yield informative answers

 

[Cremaster]

Interesting topic...

During my surgery rotation, I was one-on-one with the attendings. The first one told me I was too quiet and that some surgeons would interpret that as being weak or not knowing what's going on. A few weeks later, I got chewed out by another attending the second I opened my mouth.

I think the most important thing is to realize that the personality of surgeons runs the gamut...they don't all fit that stereotypical picture that gets conveyed on the message boards.

So, here's my advice:

1. If you have the luxury of having residents around, find out about the personality of the surgeon before setting foot in the OR. Avoid the pain of learning that somebody is a jerk after they dig into you.

2. If you're getting your balls pimped off during the surgery, I think it's safe to assume that you can initiate conversation/questions.

3. If you follow suggestion #2, you better expect to get pimped about everything that comes out of your mouth. 😉

 

[lowbudget]

I hate surgeons and wannabe surgeons.

I got chewed out by my Chief OB/Gyner because I asked to do close after the C section... which I guess I deserved because the lady was bleeding to death (according to the Chief, but when I asked the Chief was closing so I don't know what her dumb ass was talking about)...

In conclusion, Rule Number 1: don't ask questions when your C-Section is about to bleed to death AND/OR your Chief resident is pregnant herself.

Rule Number 2: Wait until everyone in the room starts talking about their kids, football, the weekend, the weather, and then bust out with "Can I ask a question?"... just make sure that your question is not something that you can look up yourself.

Rule Number 3: When you're looking to do a procedure, wait until after the procedure and ask the resident, "Hey, do you mind if I (stab the aorta) on the next case?" They'll usually say, yeah, and ask the attending on your behalf on the next case.

 

[surg]

You should definitely feel free to ask appropriate questions at appropriate times during the case. Now the trick is the word appropriate.

Please don't:
Ask questions that you should know the answer to already! You should have read about elective cases before you come to the OR. Read the patient's chart, either the night before or at least in pre-op so you know that they have colon cancer and that's why we are doing the hemi-colectomy. Emergent cases that you weren't there during the work-up is a totally different matter.

Do:
Ask questions that demonstrate a level of knowledge but seek a finer edge on it. For instance, asking what the attending's preference is in surveillance scoping the remaining mucosa during a j-pouch is a perfectly logical question that demonstrates that you understand that without a mucosectomy, there is technically a higher chance of Cancer there and that the regimen for surveillance varies from person to person without excellent data one way or the other (although there is accepted practice).

Please don't:
Ask questions at the worst times. This is a tough one because unless you know what is going on, you may not know when is a bad time. In general, if all is calm and people are chatting: good time. If all is quiet, or it is a critical portion of the case (sewing anastamoses, picking through horrible adhesions, etc), try not to ask during that time. Best way to know is to read about how to do the case before hand.

Do:
Let us know that you are interested and following along with the case at the slack times when things are going well.

Please don't:
Expect to operate unless invited. Students sometimes get offended when they aren't operating. Surgery residency is long for a reason. Even things that look simple, like closing the abdomen, are sometimes things that take a significant amount of practice and if done poorly have serious consequences (having seen more than my share of massive incisional hernias this year).

Please do:
Be prepared and enthusiastic to do minor procedures when they are offered. Closing skin and tying knots and taking off little things is something that you may be offered to do. If you do them well and are excited to do them, they may be offered more often. Practice tying knots at home, play with needle drivers so you are comfortable with instruments.

 

[16846]

Originally posted by surg
Please do:
Be prepared and enthusiastic to do minor procedures when they are offered. Closing skin and tying knots and taking off little things is something that you may be offered to do. If you do them well and are excited to do them, they may be offered more often. Practice tying knots at home, play with needle drivers so you are comfortable with instruments.

What if you are offered to do something and don't want to do it? I'm an MS-1 and want to be a psychiatrist. I really hate "invasive" medicine (anything that involves cutting/stitching, I'm fine with PD). I really have no interest in surgery and definitely don't want to do any procedures. Is this going to be a problem for me when I get to MS-3?

 

[DoctorDoom]

It could be a problem. It will look bad if you refuse an attending. Tell your residents beforehand in an honest and polite way, maybe they'll keep you out of the OR, or just make sure you are never offered a procedure. Of course if you never speak up and just keep your head down you will be able to avoid it since no one will think you are interested, which you aren't. Your grade for the rotation will suffer though.

 

[Linie]

I really hate "invasive" medicine (anything that involves cutting/stitching, I'm fine with PD).

You're fine with peritoneal dialysis???

 

[5oProlene]

Originally posted by lowbudget
I hate surgeons and wannabe surgeons.

👍 Great line!

Wannabe surgeons aren't all that bad, except for the ones who go around acting like they all already bona fide surgeons when they're still in med school.

I never know when the right time is to ask a question since it differs from surgeon to surgeon. Some seem to be willing to engage in conversation with med students, while others pretend you don't exist. I've found that you can kind of gauge it by how they interact with the resident who is first assistant on the procedure. If the surgeon talks to them often or once in a while then it is safe to assume that he wouldn't mind a student asking him a question. But if the only time he speaks is to berate the scrub nurse for not giving him what he asked for quickly enough or to yell at the resident for something, then it's probably not going to go down to well if you try to ask him a question as it will probably only irritate him.

 

[The Pill Counter]

InfiniteUni,
In medical school, everyone receives the same general medical education. I think it would be irresponsible and shortsighted to state that you're going to be a psychiatrist, and thus, do not need to learn the things that should be known by a medical doctor.

 

[16846]

Originally posted by The Pill Counter
...and thus, do not need to learn the things that should be known by a medical doctor.

When did I say this? Maybe you need to work on your reading comprehension abilities...

Furthermore, what credentials do you possess that afford you the ability to correctly gauge what a medical doctor should know or participate in during medical training?

I believe I am perfectly capable of learning whatever I will need from that subject without actually participating in something that I truly dislike and would not feel confident doing. I would imagine that there are a number of individuals who never laid a hand on a patient during a surgical procedure throughout clinical rotations and are perfectly competent physicians.

I would appreciate feedback from any practicing physicians on this, as compared to the ramblings of another judgmental medical student.

 

[Finally M3]

Originally posted by InfiniteUni
What if you are offered to do something and don't want to do it? I'm an MS-1 and want to be a psychiatrist. I really hate "invasive" medicine (anything that involves cutting/stitching, I'm fine with PD). I really have no interest in surgery and definitely don't want to do any procedures. Is this going to be a problem for me when I get to MS-3?

The best advice about 3rd year for a MS1 I can give as a grizzled, lazy MS4 is;

KEEP AN OPEN MIND.

You may be one of those lucky people who absolutely, positively, KNOW what it is they want to do when they grow up. But until you actually have rotated in your field of choice as a future physician (and not as a volunteer/allied health/etc.), don't burn all your bridges by acting disinterested, being unmotivated, etc. in your other rotations. Who knows, you might find that you have a strong distaste for malingering patients who are seeking pain meds from you all day, everyday.

😛

I was pretty certain I didn't want to go into surgery, and ultimately I'm not. But surprisingly, I had the most fun during surgery than just about every other rotation my third year. Too bad the lifestyle was so terrible...but that was b4 80 work week 😀

 

[kyra201]

I believe I am perfectly capable of learning whatever I will need from that subject without actually participating in something that I truly dislike and would not feel confident doing. I would imagine that there are a number of individuals who never laid a hand on a patient during a surgical procedure throughout clinical rotations and are perfectly competent physicians.

Just one thing to keep in mind - attendings, chiefs, and residents have told me and others that they like to see someone who is excited to learn about their field, regardless of what they are specializing in. I think it's great you know what you want to go into, but when it comes down to it - clinical grades can be affected by how interested you appear during the rotation. And grades will be important when you are applying to residency.

Hope that doesn't sound preachy. This is a post by a lazy MS IV as well 😉

 

[DoctorDoom]

Infinite Uni,

Kyra and I have both said your grade will likely suffer, so you'll have to make your decision based on that; good luck.

Despite the sarcasm, there is some good advice here. OB's though are a bit different than surgeons in the OR. Just a thought. Surgeons aren't so bad.

Originally posted by lowbudget
I hate surgeons and wannabe surgeons.

I got chewed out by my Chief OB/Gyner because I asked to do close after the C section... which I guess I deserved because the lady was bleeding to death (according to the Chief, but when I asked the Chief was closing so I don't know what her dumb ass was talking about)...

In conclusion, Rule Number 1: don't ask questions when your C-Section is about to bleed to death AND/OR your Chief resident is pregnant herself.

Rule Number 2: Wait until everyone in the room starts talking about their kids, football, the weekend, the weather, and then bust out with "Can I ask a question?"... just make sure that your question is not something that you can look up yourself.

Rule Number 3: When you're looking to do a procedure, wait until after the procedure and ask the resident, "Hey, do you mind if I (stab the aorta) on the next case?" They'll usually say, yeah, and ask the attending on your behalf on the next case.