Scrubbing in and OR Shadowing

[cavalier329]

I read in some other posts that it is not a good idea to mention that youve scrubbed-in to any surgeries.

I can see how this can be seen as unethical, however, I am looking for a way to mention the fact that the docs let me scrub in only to practice proper sterile techniques and to learn how to do it. After that, I usually stood behind the table. Never had any contact with the patient. How could this be stated--if I should state it at all? I think it was a good experience.

I also watch CABG and valve replacement surgeries on a weekly basis. Ive probably seen around 20 of each. How can I state this because I also feel this was a good experience but Ive read in other posts that its very rare for a premed to see that stuff. I observe but dont do anything but I want to be careful so that no one thinks the doctors or I did anything unethical.

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[WellWornLad]

What? How is this unethical? As long as the surgeon is not letting you "take a crack at this bypass" I'm not sure I understand what the problem is.

Edit: I'm not sure where you plan on mentioning this, but IMHO one-off shadowing experiences are best left off AMCAS/personal statements. Better to bring it up during the interviews, if possible.

 

[cavalier329]

wherever i would write about what ive been doing outside of the classroom for 4-5 years...

not my PS though

 

[MilkmanAl]

I wore scrubs at every single one of my shadowing opportunities. I got mistaken for a med student pretty frequently but only ever got seriously asked to do something (hand over atropine, epi, or something) when patients coded.

 

[LikeClockWork]

I wore scrubs at every single one of my shadowing opportunities. I got mistaken for a med student pretty frequently but only ever got seriously asked to do something (hand over atropine, epi, or something) when patients coded.

There's a difference between "wearing scrubs" and "scrubbing in."

 

[MilkmanAl]

I'm not sure I follow...

 

[LikeClockWork]

I'm not sure I follow...

The OP was talking about "scrubbing in" (using sterile procedure to prep oneself to perform/participate in surgery; something very few doctors would take the time to let a shadower do).

You told a story about "wearing scrubs" (wearing hospital issued clothes that many doctors wear; often required of all personnel in areas of the hospital). It led me to think maybe you were confused with the terminology.

 

[cavalier329]

indeed.

 

[MilkmanAl]

Oh, I gotcha. I assumed what you're describing as "scrubbing in" was just standard procedure for being in an OR. I've never done it any other way. So yeah, I was confused with the terminology.

 

[Caesar]

There's a difference between "wearing scrubs" and "scrubbing in."

a very large difference to boot.

 

[LikeClockWork]

Oh, I gotcha. I assumed what you're describing as "scrubbing in" was just standard procedure for being in an OR. I've never done it any other way. So yeah, I was confused with the terminology.

You mean that, at every surgery you've observed, every person in the room went through sterile procedures (wash, scrub, pick, dress, all that)? Even the techs?

 

[MilkmanAl]

When I shadowed at private practices, yes. While I was at hospitals, I was moving from room to room and never saw the operating staff come in - not that I remember, anyway. I had to go through sterile procedure each time, though, as did the doc I was with.

 

[LikeClockWork]

When I shadowed at private practices, yes. While I was at hospitals, I was moving from room to room and never saw the operating staff come in - not that I remember, anyway. I had to go through sterile procedure each time, though, as did the doc I was with.

Well then I'm pretty jealous. I just put on scrubs, a mask, cap, and stood in the corner.

 

[AmoryBlaine]

In most hospitals (probably all teaching hospitals) a shadowing pre-med student would not be allowed to scrub in to a surgery.

If an attending you are shadowing is letting you do this he/she is probably breaking some rules. It's their arse, not yours but you should be aware of it.

At my institution technically you weren't allowed to scrub in until you were an M3. It actually kind of makes sense since sterile technique is serious business. Not to say that pre-meds aren't capable of learning how to do it since a 10 year old could, just that it's ok to limit certain things to senior medical students.

 

[riceman04]

Edit: I actually got some pretty awesome (and very logical) advice from a poster. I have subsequently edited this post

I actually had the opportunity to scrub in to several sugeries (as part of this program that was once at Baylor College of Medicine).

 

[T12]

No one really addressed how observing a surgery is unethical...???

Or pardon, why washing thoroughly before observing said surgery is unethical?

 

[chrisisinnocent]

No one really addressed how observing a surgery is unethical...???

Or pardon, why washing thoroughly before observing said surgery is unethical?

Because the patient signs a release to allow med students to participate in their care in order for them to be educated not for some random person off the street to come in and be involved in their surgery.

 

[Blade28]

Yeah, it's not contaminating the sterile field that's the main fear (though infection is certainly a risk), but rather the potential liability were anything to happen with a non-med student "actively participating" in the case.

 

[LikeClockWork]

I think the OP scrubbed in just for the fun of it/educational experience. Once all washed up they stood in the corner like every other pre-med. I can't imagine any ethical problems with someone unqualified getting sterile as long as they're not participating. I do suppose the term "scrubbing in" implies a certain level of involvement in the surgery that a pre-med shouldn't have though.

 

[MossPoh]

It is unethical to participate. Not to watch. If you scrubbed in for real (not just put scrubs and a mask on) and were within the sterile field but didn't do anything then it doesn't matter. I scrubbed in a few times for the experience, but also because the scrubtech and PA made speciall space for me to get closer to the surgeries. I've probably seen 50+ surgeries and it wasn't by any means common for me to scrub though. As Armory said, the physician was putting their arse on the line. I reduced some fractures and a dislocated shoulder amongst other things in the ER, but every time I did it was stressful from the legality aspect. We ask the patient numerous times whther it was ok. Closed the blinds. Closed the door. Verified again. Then did it with an eye on the door. This was in an area that is not prone to being sue happy as well.

The experience is one reason why I am pretty set on the surgical side of things. I feel very comfortable in the OR and in the ER, but rounding and talking to patients felt kind of awkward and dull to me.

 

[blazinfury]

So ultimately the impression that I get is that wearing scrubs while being in an operating room and standing in the corner of the room is ok, since the student is not participating in the surgical procedure in any way. Am I correct?

 

[echidna]

While studying abroad I worked in a teaching hospital and was allowed to scrub in and also participate to some extent. Retracting organs, irrigating, even a few sutures. I too was told by an advisor to NOT mention this in an interview, but I figure if it was ok with the surgeon, why wouldn't it be considered ethical? I'd love to bring it up since it's by far the coolest clinical experience I've had.

 

[LikeClockWork]

While studying abroad I worked in a teaching hospital and was allowed to scrub in and also participate to some extent. Retracting organs, irrigating, even a few sutures. I too was told by an advisor to NOT mention this in an interview, but I figure if it was ok with the surgeon, why wouldn't it be considered ethical? I'd love to bring it up since it's by far the coolest clinical experience I've had.

Contrary to what they may tell you, surgeons are not the gatekeepers of ethics. Just because a doctor does something does not necessarily mean it's ethical.

 

[mbe36]

I know it would have been illegal for me to scrub in during my OR experience due to the fact that I was not a matric. med student.

 

[silverlining1]

I mentioned scrubbing in in my PS and did gain acceptance to 1 school plus a few waitlists. Not sure if it held me back in any way, but I was never asked about it in an interview. From my PS:

I reached into the chest cavity and touched the section of lung that Dr. Donington held. In the midst of the tender, flexible tissue of the lung, the tumor felt like a small ball of day-old clay. "I'm going to cut out the portion of the lung where the tumor is. This won't really harm the patient's lung function; in fact, a person can survive with just one good lung," Dr. Donington explained. I moved my hand out of the chest cavity and held a retractor...

 

[BigTuna88]

I don't think it is a problem. I mentioned in my personal statement that scrubbing in with my dad was one of those defining moments for me in deciding medicine was right for me. My pre-med adviser, who has been doing the same job for over 30 years and who knows countless deans of admissions (so her opinion is pretty valid) never once told me I should take it out. At the end of it all I got 6 interviews, and of the 4 I went to was accepted to three. I don't think it hurt me one bit.

 

[ACSurgeon]

In most hospitals (probably all teaching hospitals) a shadowing pre-med student would not be allowed to scrub in to a surgery.

If an attending you are shadowing is letting you do this he/she is probably breaking some rules. It's their arse, not yours but you should be aware of it.

At my institution technically you weren't allowed to scrub in until you were an M3. It actually kind of makes sense since sterile technique is serious business. Not to say that pre-meds aren't capable of learning how to do it since a 10 year old could, just that it's ok to limit certain things to senior medical students.

Same here. I shadowed an orthopod and he called a nurse and said that med student needed to be taught sterile technique/scrubbing and when I went to the nurse educator, she asked what year I was and refused to "educate" me after learning I was an M1. Sucks, but oh well.

 

[Handy388]

I mentioned scrubbing in in my PS and did gain acceptance to 1 school plus a few waitlists. Not sure if it held me back in any way, but I was never asked about it in an interview. From my PS:

I think it held your back.

The cardinal rule of surgery, which all of you should read before start to do anything, is "least amount of unnecessary personel in the sterile field"

 

[Doctor4Life1769]

In most hospitals (probably all teaching hospitals) a shadowing pre-med student would not be allowed to scrub in to a surgery.

If an attending you are shadowing is letting you do this he/she is probably breaking some rules. It's their arse, not yours but you should be aware of it.

At my institution technically you weren't allowed to scrub in until you were an M3. It actually kind of makes sense since sterile technique is serious business. Not to say that pre-meds aren't capable of learning how to do it since a 10 year old could, just that it's ok to limit certain things to senior medical students.

Thank you. I was wondering how these pre-meds were able to scrub in whereas a person like myself about to enter MS-2 wasn't. Sounded fishy, I guess certain areas bend the rules or he knows the attending on a personal level.

 

[chad5871]

I don't think scrubbing in on a surgery would make the applicant look bad, but it certainly would make the institution and surgeon look bad. I don't really think there's anything wrong with stating you were able to "scrub in and observe."

 

[Handy388]

I don't think scrubbing in on a surgery would make the applicant look bad, but it certainly would make the institution and surgeon look bad. I don't really think there's anything wrong with stating you were able to "scrub in and observe."

I think it says certain things about the applicant as well. It sends out the message that they are so desperate for medical school that they are willing to compromise patient's safety (if you don't know why, read any textbook on surgery). I love surgery as much, if not more, as the next guy, but I know when to stop because patients always come first.

 

[Jolie South]

I think it says certain things about the applicant as well. It sends out the message that they are so desperate for medical school that they are willing to compromise patient's safety (if you don't know why, read any textbook on surgery). I love surgery as much, if not more, as the next guy, but I know when to stop because patients always come first.

pre-meds have what knowledge of patient care to make that determination? that's why they're shadowing in the first place; to get familiar with what doctors do and observe patient care.

you can't be expected to know the details of surgical practice (or whatever) before med school.

 

[Doctor4Life1769]

I think it says certain things about the applicant as well. It sends out the message that they are so desperate for medical school that they are willing to compromise patient's safety (if you don't know why, read any textbook on surgery). I love surgery as much, if not more, as the next guy, but I know when to stop because patients always come first.

If the doc allows them to scrub in, I don't think many will refuse. However, it doesn't take common sense to acknowledge patient safety either.

 

[Terpskins99]

Thank you. I was wondering how these pre-meds were able to scrub in whereas a person like myself about to enter MS-2 wasn't. Sounded fishy, I guess certain areas bend the rules or he knows the attending on a personal level.

They shouldn't.

Its a liability issue. As a medical student, your school is required to provide insurance coverage on your behalf should any instance of malpractice occur during rotations. I would have assumed that you would be covered even as an MS2, but it could depend on your medical school's specific insurance policy.

 

[annndyr]

Why does it matter whether the OP actually 'scrubbed in' or not?

The bottom line is that it was a shadowing experience. Of course you can put this on yoru AMCAS or in your PS.

 

[Handy388]

pre-meds have what knowledge of patient care to make that determination? that's why they're shadowing in the first place; to get familiar with what doctors do and observe patient care.

you can't be expected to know the details of surgical practice (or whatever) before med school.

infection control is taught in college level biological science classes that are required for premeds.

 

[ZagDoc]

Why does it matter whether the OP actually 'scrubbed in' or not?

The bottom line is that it was a shadowing experience. Of course you can put this on yoru AMCAS or in your PS.

Liability/ethical issues, as others have stated in this thread. Being in an OR and observing is one thing. Being in the sterile field and participating is another completely different can of worms, both because of legal culpability in the case and because its considered very taboo. In a malpractice suit, if the prosecuting attorney found out a non-authorized personnel was scrubbed on the case, they'd have a field day, whether due to a botched procedure or procedure-associated infection and whether the person actually participated or not. And yes, that big of a difference is implied by saying "scrubbing in" instead of "being sterile in an OR."

The traditions, procedures, and hierarchy of a surgical OR are something you can't really understand until you've been there, but its more "no s#!t tolerated" than anything I have every encountered in this world. Anal tendencies abound.

Like others said, none of this is on the shadowing pre-med of course, its all on the surgeon, but still, an ADCOM reading about a pre-med scrubbing in on a case will cause an instinctual uneasiness, not the desired "wow, this applicant really immersed their self in medicine" effect.

I second the recommendation to change the language to "scrub and observe."

infection control is taught in college level biological science classes that are required for premeds.

Sterile technique in the OR and sterile technique in micro lab are very different things. The countertop antibiotic-sensitive strep you grow on agar plates in undergrad are nothing like the stuff that grows in hospitals these days.

 

[Blade28]

Sterile technique in the OR and sterile technique in micro lab are very different things. The countertop antibiotic-sensitive strep you grow on agar plates in undergrad are nothing like the stuff that grows in hospitals these days.

Well-said.

I was a whiz at "sterile technique" in my biochem lab during undergrad. It probably took me close to 2 1/2 years before I truly felt 100% comfortable in the OR.

 

[RySerr21]

my best friend has an internship at a hospital in LA. hes doin reseasrch with a surgeon and he gets to scrub in a few times a week.

he told me that last surgery he was holding open the incisiion with whatever tool you use to do that...he also said the doctor let him do a few stitches when they were closing up.... he sounded surprised when I said "are f*ckin kiddin me. there is NO way that is legal/ethical." i dind't believe him at first b/c i thought the doctor could get in serious **** but i'm pretty sure he was tellin the truth. pretty crazy.

 

[Terpskins99]

my best friend has an internship at a hospital in LA. hes doin reseasrch with a surgeon and he gets to scrub in a few times a week.

he told me that last surgery he was holding open the incisiion with whatever tool you use to do that...he also said the doctor let him do a few stitches when they were closing up.... he sounded surprised when I said "are f*ckin kiddin me. there is NO way that is legal/ethical." i dind't believe him at first b/c i thought the doctor could get in serious **** but i'm pretty sure he was tellin the truth. pretty crazy.

I can't say I'm surprised. Attendings sometimes lump pre-meds and medical students (and under bizarre circumstances interns) altogether as simply "trainees".

There is no real magic to holding open a wound or throwing a stitch. My training for properly handling a laparascopic camera during a cholecystectomy consisted of a surgeon plopping it into my hand and saying "here, hold this".

 

[AmoryBlaine]

They shouldn't.

Its a liability issue. As a medical student, your school is required to provide insurance coverage on your behalf should any instance of malpractice occur during rotations. I would have assumed that you would be covered even as an MS2, but it could depend on your medical school's specific insurance policy.

Another issue of liability that has not been covered is if the shadowing student were scrubbed in and then (god forbid) nailed with a needle or cut with a blade.

At some point in our career many of use will get stuck (I have). If the person is just a pre-med shadowing who pays for all the testing that may have to be done? I've had medical student colleagues who have had to go to the ER for blood draws etc etc. If the patient turns out to be HIV+ you might have to take 6 months of ART.

Maybe your undergrad/work-based insurance would cover this but I could see them refusing. It is not that difficult to imagine one of the insurance bereaucrats saying, "let me get this straight, you as a junior in college scrubbed into an open surgical procedure in violation of hospital policy and now want us to pay for the care? Yeah right ..."

How careful you are is important, but not the whole story. In my case I just made a stupid mistake. A friend of my was looking at the Mayo stand and a resident basically threw a needle driver at his hand by accident. Same result in the end.

 

[cavalier329]

I think it says certain things about the applicant as well. It sends out the message that they are so desperate for medical school that they are willing to compromise patient's safety (if you don't know why, read any textbook on surgery). I love surgery as much, if not more, as the next guy, but I know when to stop because patients always come first.

Lets not go crazy here. That is a bit of a stretch don't you think? First of all, patient safety wasn't compromised because I and the nurse were in the corner working on the whole sterile technique thing...about 20 ft away from the pt. Now, if the doctor told me to stick my hands right in there and lift the heart up and I dove right in, then yea, i would probably question my competency. However, that is not what happened.

Now, step off your ethical soap box. I am pretty sure medical school isn't on my mind 95% of the time outside of class. In class, I gotta think about it or else I get lazy. But lets not go crazy and say I was so desperate that I was willing to be unethical and incompetent. Come on now.

 

[cavalier329]

wow, that post just annoyed me haha

 

[Blade28]

At some point in our career many of use will get stuck (I have).

Good point.

I've often been told that surgery residents should expect to get stuck about once a year, on average. I've been stuck twice so far, so it's working out.

Edit: I should note that many sticks are from OTHER people accidentally poking you with a scalpel/needle.