Shadowing in OR

[Pose]

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Greetings,

Can anyone inform me on the general process of entering the OR? I arranged to shadow a neurosurgeon at the hospital I work at, however it never happened because I was clueless from the moment I entered the department. I have very basic questions.

I put on a cap and am buzzed into the Surgery department. From there I am greeted by the surgeon who makes his way into the "employee only" room with locker rooms. I suppose I follow him there, change into scrubs (or change my scrubs, if I had been working that day). I follow him to outside of the operating room where he scrubs in, and then enters the room. A tech (or nurse) helps him gown and glove. Do I follow his every move?

When I went to the OR the day I was to shadow, no one would help me find the surgeon, nor the locker room, nor give me the code to the locker room when I did find it. I had no idea what I needed to do. Next time I'm going to keep the surgeon within eye sight.

Cap/hair net: can either work? I have shortish hair and sideburns. Does it matter which I use to cover my head? How much hair needs to be covered? Ears?
Mask: if I'm shadowing, do I need a mask with the eye shield, or just something to cover my mouth/nose?
Shoe covers/gloves: do I need them to stand in the OR?
Scrubs: in the ED, we all wear shirts under our tops. As a guy, nothing goes under my scrub top, right? Does the scrub top need to be tucked in?

Sorry for the length and stupidity of this, but the OR staff was very unhelpful and even rude. I would appreciate any advice whatsoever.

 

[Pir8DeacDoc]

These can be awkward experiences and you're doing the right thing to ask. It's actually a shame that the OR nurses were so unhelpful. Anyway, I'd definitely recommend sticking close with the surgeon until you get a little more comfortable. And.............

You can rock the cap or hairnet. Where I went to medical school the docs all wore caps but in our residency a lot more of the surgeons rock the shower cap. Either is fine. No need to worry about covering your ears.

I think for shadowing you could go without the face shield on your mask, but some hospitals may have a policy that anyone in the OR needs a shield or some protective eye wear. I'd just go with the regular mask until told otherwise.

Shoe covers aren't necessary but might be worth wearing depending what sort of shoes you have on. You can't really go wrong wearing them. If they are everyday shoes you don't want OR debris on them anyway.

You can probably wear a shirt under your scrub top if you want as you aren't going to scrub so the risk of contaminating or being able to scrub above the elbows is eliminated. However, to be on the safe side I'd avoid a shirt under. You can tuck or not tuck the scrub top but nearly every surgeon I've ever worked with tucks (at least those that can fit their belly under a scrub top). If makes you look professional.

Feel free to PM me if you have any more specific questions.

 

[-Goose-]

Greetings,

Can anyone inform me on the general process of entering the OR? I arranged to shadow a neurosurgeon at the hospital I work at, however it never happened because I was clueless from the moment I entered the department. I have very basic questions.

I put on a cap and am buzzed into the Surgery department. From there I am greeted by the surgeon who makes his way into the "employee only" room with locker rooms. I suppose I follow him there, change into scrubs (or change my scrubs, if I had been working that day). I follow him to outside of the operating room where he scrubs in, and then enters the room. A tech (or nurse) helps him gown and glove. Do I follow his every move?

When I went to the OR the day I was to shadow, no one would help me find the surgeon, nor the locker room, nor give me the code to the locker room when I did find it. I had no idea what I needed to do. Next time I'm going to keep the surgeon within eye sight.

Cap/hair net: can either work? I have shortish hair and sideburns. Does it matter which I use to cover my head? How much hair needs to be covered? Ears?
Mask: if I'm shadowing, do I need a mask with the eye shield, or just something to cover my mouth/nose?
Shoe covers/gloves: do I need them to stand in the OR?
Scrubs: in the ED, we all wear shirts under our tops. As a guy, nothing goes under my scrub top, right? Does the scrub top need to be tucked in?

Sorry for the length and stupidity of this, but the OR staff was very unhelpful and even rude. I would appreciate any advice whatsoever.

http://forums.studentdoctor.net/showthread.php?t=201961



Hey there,

Above is a good thread about a first time experience in the OR. Great information on it.

I'm sorry your experience with the OR staff was less than ideal. Make sure that you are not too timid and introduce yourself to the OR staff. Especially the circulating nurse, who will most likely have to make note of the fact that you were present.

Definitely tuck the top in. This is not the ED. 🙂

Good luck.

 

[Blade28]

I doubt you'll be scrubbing in (thus being sterile) - if you are, it's not enough to just copy the attending. Likely someone will have to show you how to do this.

If you're just observing, wearing scrubs, a cap and mask is enough.

 

[Winged Scapula]

Good responses above guys.

All your hair should be covered; if you have short hair then the surgical cap will work. I always leave a little out at the top because I hate getting a line across my forehead and I've only had a couple of nurses get on me about it.

If your sideburns are mutton chop, Elvis type, then you will have to wear the cap with the beard cover. Otherwise, either shower cap or surgical cap. Seems to be hospital and service dependent, in addition to hair length.

Please tuck your shirt in. Like someone said, this isn't radiology, the ED or path!

If you aren't scrubbing, I'd wear a t-shirt (short sleeve of course) underneath my scrub top because in addition to the reasons given above, it gets pretty cold in the rooms if you aren't scrubbed.

Next time, tell the Neurosurgeon you were having some trouble getting into the locker room and see if you can arrange to meet him early, so as to have him let you in. Otherwise medical students or most residents should take some pity on you. OR nurses are not known to mollycoddle students.

 

[blotto geltaco]

Please tuck your shirt in. Like someone said, this isn't radiology, the ED or path!

And you don't want to look like the fat slobby nurses who are too enormous and lazyto tuck their shirts in.

 

[MossPoh]

I can't tuck scrubs in, but that is because they didn't have a big enough top. 😉 Disadvantages to being 6'5" with broad shoulders I guess.

But yea, when I shadowed surgeons I tended to just follow around the surgeon. He even recommended which mask to use, since evidently some of them smell funny. I walked in there and I introduced myself to the nurses and then asked where the least obstructive place to stand with a good view is. Many times the Anesthesiologist just made room for me and I stood there and watched over the curtain. If it was a larger OR there were never really any problems. I did get blood on me, so wearing the shoe covers probably isn't a bad idea, unless you don't care about your shoes much.

Make sure someone gives you lead if you are shadowing any speciality that uses the fluoroscope. In my situation it was quite the endeavor because of my size...I actually had to borrow one of the radiologist's once. (Not a problem since I know everyone in the department)

The major thing is to not be afraid to ask questions about the procedure. There is bound to be at least one person who understands you have never really done this before. Please do realize that there are proper times to ask questions and times it is best to just shut up and let them work as well. 😉 It seems like a given, but some people just don't get the point.

 

[Blade28]

And you don't want to look like the fat slobby nurses who are too enormous and lazyto tuck their shirts in.

Agreed.

 

[doc02]

He even recommended which mask to use, since evidently some of them smell funny.

Um, that's not the mask, dude. The masks don't smell.

 

[Blade28]

Um, that's not the mask, dude. The masks don't smell.

Yeah. There are basically two kinds of masks - those with the plastic face-shield and those without. Both have pretty neutral odors.

 

[doc02]

You know what would be funny? If he was like, "yeah, the surgeon was soooo nice, he showed me that trick of how to wear a mask at all times, sometimes two masks at once! Also, he stood on the other side of the room."

 

[Blade28]

You know what would be funny? If he was like, "yeah, the surgeon was soooo nice, he showed me that trick of how to wear a mask at all times, sometimes two masks at once! Also, he stood on the other side of the room."

Or: "He even helped me out by choosing which mask I should wear! Here it is, it's nice and teal-colored, and says N-95 on the side!"

 

[Pose]

That's pretty amusing -- and I wouldn't put it past the surgeon I'm shadowing to play a prank on me. I deal with him often in the ED, as he is our main neuro coverage for trauma, and he operated on my back a year ago.

Anyway...thank you all for the advice. My sideburns aren't mutton chop -- they're not thick, and extend only a little below my ears. So my checklist:

Surgical cap: check
Mask: check
Tuck in scrub top: check
Don't let surgeon sneak away (within reason -- I won't follow him to the bathroom): check

Interesting point about the lead. I imagine quite a few of the spine cases I'll be watching will use fluoroscopy.

Thanks again.

 

[-Goose-]

The major thing is to not be afraid to ask questions about the procedure. There is bound to be at least one person who understands you have never really done this before. Please do realize that there are proper times to ask questions and times it is best to just shut up and let them work as well. 😉 It seems like a given, but some people just don't get the point.

That said, be sure not to ask too many questions. There is a fine line between being interested in the work & being annoying. Tread carefully. You don't want to be that guy who blurts out "Dr. Soandso, I read last night in JAMA that [insert esoteric/irrelevant fact here]" as the dura is being opened.

This is very dependent upon the personality of the surgeon you are shadowing. Some are of the old-school speak-when-spoken-to, yes-sir, no-sir mentality. Others are not.

 

[Cheisu]

Greetings,

Can anyone inform me on the general process of entering the OR? I arranged to shadow a neurosurgeon at the hospital I work at, however it never happened because I was clueless from the moment I entered the department. I have very basic questions.

I put on a cap and am buzzed into the Surgery department. From there I am greeted by the surgeon who makes his way into the "employee only" room with locker rooms. I suppose I follow him there, change into scrubs (or change my scrubs, if I had been working that day). I follow him to outside of the operating room where he scrubs in, and then enters the room. A tech (or nurse) helps him gown and glove. Do I follow his every move?

When I went to the OR the day I was to shadow, no one would help me find the surgeon, nor the locker room, nor give me the code to the locker room when I did find it. I had no idea what I needed to do. Next time I'm going to keep the surgeon within eye sight.

Cap/hair net: can either work? I have shortish hair and sideburns. Does it matter which I use to cover my head? How much hair needs to be covered? Ears?
Mask: if I'm shadowing, do I need a mask with the eye shield, or just something to cover my mouth/nose?
Shoe covers/gloves: do I need them to stand in the OR?
Scrubs: in the ED, we all wear shirts under our tops. As a guy, nothing goes under my scrub top, right? Does the scrub top need to be tucked in?

Sorry for the length and stupidity of this, but the OR staff was very unhelpful and even rude. I would appreciate any advice whatsoever.

how old are you?

 

[Winged Scapula]

I forgot:

- brush up on your 70s "classic rock and roll" trivia
- learn how to operate the CD player in the OR

If Orthpods like to talk about sports, Gen Surgeons about porn, what do Neurosurgeons talk about?

(I dunno, just wondering)

 

[Pose]

Early twenties.

Why?

As far as questions -- I'll try not to throw out questions just to hear myself. Not really in my personality. I'm going to look over the particular cases before we go into the OR to answer the sickingly basic stuff. I'm really there just to get a broader feel of medicine. The OR is like a different world.

Oh, and Dr. Cox, I'll be certain to let you know.

...I think I need to shadow a general surgeon.

 

[Winged Scapula]

Early twenties.

Why?

Cheisu is our resident teenager. We like to bully him about his age, so perhaps he was looking for another Gen Zer.

Oh, and Dr. Cox, I'll be certain to let you know.

I'm betting on cars or golf.

...I think I need to shadow a general surgeon.

Maybe you do.

The females don't tend to talk about porn as much. I had a patient remember I was talking about scorpions (not the 80s band but rather the bug) when she was going to sleep.

 

[Castro Viejo]

what do Neurosurgeons talk about?

(I dunno, just wondering)

How great they are... 🙄

 

[Blade28]

I had a patient remember I was talking about scorpions (not the 80s band but rather the bug) when she was going to sleep.

I'm very fond of scorpions. And that's all I'll say about that.

 

[Winged Scapula]

I'm very fond of scorpions. And that's all I'll say about that.

Then you should have moved here...there are apparently quite a few of them.🙁

I am more fond of the 80s band than I am of the variety we have here.

 

[Chronic Student]

As far as talking in the OR, if the surgeon is talking then an occasional question is OK. If they are quiet you should be too.

The dissection part is not usually the stressful (trying to pay attention) part for the surgeon. However, once the dura is opened or they are down on the nerve roots, than its better not to talk.

Just my .02.

BTW, I was never that much of a jerk as a scrub tech, I would have helped you figure stuff out.

-Mike

 

[Flopotomist]

Great thread. I guess I have been "lucky" when in the OR as a pre-clinical med student in that I am completely ignored. Unfortunately, this means I really (still) have no idea how to properly attire myself, don't really understand the reason I can't wear a t-shirt under my scrubs etc.

What I REALLY don't understand though is the lack of enthusiasm on the part of residents and attendings towards recruiting the next generation of surgeons by introducing medical students with no OR background to the culture.

What I am trying to say is that if you go into an ED (even when busy), or pretty much any clinic, the staff (at least with me) has always been enthusiastic about setting you up to succeed. They show you where you should be, what you should be doing/not doing, and at least acknowledge your presence.

In the OR, I feel obligated to hide in the corner and pray that I don't move too quickly lest the lions attack.

When I relate my experiences to my peers, they congratulate me on having had a "good" experience because I was not humiliated, berated, and managed to not piss anybody off. I find it sad that a "good" experience is defined as such.

Wow.. that felt good to vent.

 

[Cheisu]

Cheisu is our resident teenager. We like to bully him about his age, so perhaps he was looking for another Gen Zer.

🙁 lol

 

[Castro Viejo]

What I REALLY don't understand though is the lack of enthusiasm on the part of residents and attendings towards recruiting the next generation of surgeons by introducing medical students with no OR background to the culture.

It's not really a lack of enthusiasm, but the culture doesn't quite allow you (as a surgical resident) to just start catering to the new kid in the room.

When you're the resident in the room, you're expected to get everything ready for the attending. To make sure Anesthesia doesn't do anything bad. To try and decrease the MAFAT index. You're also expected to look as if you're thinking deeply about what you're about to do, what incision you want to make, how you're going to go about the dissection and whatever else you plan on doing that day.

Then you're expected to review the relevant radiographic studies.

Then you're supposed to help the OR nursing staff so they don't think you're some kind of Primadonna. Put on the squeezers... Put the patient up in stirrups... Put the Foley in... 🙄

Any deviation from this, including talking to the kid without a clue in the room and just blabbing about utter nonsense, and you'll look like a total slacker. Your attending will lose confidence in you and the case may be taken away.

But that doesn't mean we won't ever talk to you. Usually if you stay quiet enough and out of the way, I'll tap your shoulder and tell you to go scrub. And while we're at the scrub sink, scrubbing away, we can talk about anything you want. That is, of course, unless the attending shows up and the conversation will have to be about the case and the patient.

There are good points during the case in which to talk, and unfortunately, the pre-incision time when we're all trying to get the case going just isn't the right time. And ORs are generally busy. Every OR in the world is running at least an hour behind schedule on any given day. So, yeah, the busy clinic, or the ED may be more accomodating and the OR may not be the friendliest place in the world, but once you've been here a while and you get to know everyone, it's great.

 

[Pir8DeacDoc]

I've mentioned this many times before on this site but I firmly believe that every tech and OR nurse sees it as their mission in life to harass medical students about sterile technique. Once you become a resident a lot of that BS goes away. Hell I think the attendings could operate in jeans and no mask if they wanted to. Just hang in there. As others have mentioned, the OR is a haven all its own, once you've become a part of it there is no place better. Just have to get through the awkward stage of learning your way around.

 

[Blade28]

As others have mentioned, the OR is a haven all its own, once you've become a part of it there is no place better.

Amen, brother.

 

[Winged Scapula]

🙁 lol

We only hurt the ones we love, right?!

 

[Winged Scapula]

Like Castro said, while sometimes it may be the personalities of the surgery residents that aren't interested in teaching and welcoming the younger generation, most of the time its pressure to get everything done.

For example, to get the room ready when I was doing a big colorectal case:

- bring up the CT scan on the PACs; make sure the right images were showing on the huge screen in the room
- have the pre-op labs up on the screen if the attending wanted to view them; since this was the same computer that anesthesia used, I would have to check often to make sure they hadn't closed the EMR window or changed it to search another patient, etc.
- get the pre-printed post-op pathways (which weren't yet in the computer) out of the drawer, poke holes in the them and make sure they got into the chart
- get the patient from the holding area with anesthesia; direct family to waiting room, tell them the same things the nurse and the anesthesia resident did.
- once in the room, assist moving the patient to the OR table
- get blankets for the patient
- wander around aimlessly, calling the intern, etc. while anesthesia is putting in an epidural
- assist with some cricoid pressure
- put on squeezers
- place the Foley
- put the yellow fins on the table (not the blue ones, she doesn't like those)
- get a step nearby because the attending is short and will want one; they are never in the room when you need them
- shave the patient
- make sure anesthesia has given the antibiotics
- get my gloves out if I'm with a scrub that didn't know my size
- move the patient up or down on the table, so the anus is at the break in the table
- call the attending and tell him/her we are ready


and so on...every attending is so specific about what they want and can be pretty upset if you don't get it right. If I know the attending is running late and we have time, I'll get you (the student) to put the Foley in, but frankly, its quicker if I do it. The circulator will do it, but then that just means she isn't getting out suture and other stuff required. Plus, I'm faster.

So, I am sorry that your experience was negative because most of us do care, sometimes we just don't have time to show it.

 

[Castro Viejo]

Like Castro said, while sometimes it may be the personalities of the surgery residents that aren't interested in teaching and welcoming the younger generation, most of the time its pressure to get everything done.

Hell, where I went to med school the residents even had to prep the belly.

Thank God for financially-stable and well-off community hospitals. 🙂

 

[Arch Guillotti]

To make sure Anesthesia doesn't do anything bad.

oh good lord tim don't you realize that you have got it backwards, we are the ones watching to make sure you guys don't screw up🙄

 

[jocg27]

I had a patient remember I was talking about scorpions (not the 80s band but rather the bug) when she was going to sleep.

Did she have acute pancreatitis secondary to scorpion sting?

 

[Pose]

I must put in 30 foleys a day -- maybe I can be useful in the OR, afterall.

 

[jocg27]

surgery was my first rotation, so at least the residents and nurses were actually nice enough to me on my first day in the OR, on the first day of 3rd year. They actually let me put the Foley in...now the surgeon...his first and only words to me for the day were, with a smirk as I was placing the catheter, "Have you ever seen a penis before?"

(I am male)

(Not that it's much better of a comment to make to a female)

Harmless enough, of course...but definitely the OR is a pretty new and unique place the first time you are in there.

 

[Winged Scapula]

Did she have acute pancreatitis secondary to scorpion sting?

LOL.

No, if she had she probably wouldn't have been in the operating room.

The anesthesia resident and I were talking about me moving to Arizona and all the scorpions here and the patient asked me about it in the PACU when she woke up.

 

[Castro Viejo]

oh good lord tim don't you realize that you have got it backwards, we are the ones watching to make sure you guys don't screw up🙄

If you're watching us, who's watching you? Oh, riiiiiiiiiight... Your Anesthesia computer that bleeps when something bad happens and signals you to stop surfing the web during the case.

 

[dilated]

I've scrubbed in wearing a t-shirt under my scrubs and seen a lot of residents do it too. Is this institution dependent or something?

 

[Castro Viejo]

surgery was my first rotation, so at least the residents and nurses were actually nice enough to me on my first day in the OR, on the first day of 3rd year. They actually let me put the Foley in...now the surgeon...his first and only words to me for the day were, with a smirk as I was placing the catheter, "Have you ever seen a penis before?"

(I am male)

(Not that it's much better of a comment to make to a female)

Harmless enough, of course...but definitely the OR is a pretty new and unique place the first time you are in there.

My first Foley was as a first-year med student doing an ER elective. The surgical intern (a woman) said, inadvertently I believe, "Now grab the penis. No, really grab it. Like you're trying to choke a chicken and point it straight up toward the ceiling like you're trying to rip it off him. Now you can put the Foley in."

All that frustration being a woman in surgery I guess gives you a unique perspective on things. I actually think she became a urologist...

 

[jocg27]

My first Foley was as a first-year med student doing an ER elective. The surgical intern (a woman) said, inadvertently I believe, "Now grab the penis. No, really grab it. Like you're trying to choke a chicken and point it straight up toward the ceiling like you're trying to rip it off him. Now you can put the Foley in."

All that frustration being a woman in surgery I guess gives you a unique perspective on things. I actually think she became a urologist...

lol...putting in Foleys seems to be one of their favorite chances to mess with students' minds....a couple days after the above story, I also got "No, don't hold it like a teacup.....hold it like it's Saturday night!"
Seriously...

 

[Arch Guillotti]

If you're watching us, who's watching you? Oh, riiiiiiiiiight... Your Anesthesia computer that bleeps when something bad happens and signals you to stop surfing the web during the case.

🙄

 

[gasnewby]

I've seen male attendings harass male med students/interns.

"No, that's not the urethra! Aren't you married? Is your wife happy? Is this the first time you've seen it with the lights on?"

 

[Chronic Student]

MAFAT, one of my favorite acronyms. (Mandatory Anrsthesia Fart/F**K Around Time). No offense anesthesia folks. We know you have to take care of the patient from your end, we just love to harrass you about it.

Secondly, I was a scrub and I really tried to be nice to the med students and residents in the OR. However, it is a major pain in the butt when someone contaminates the field, especially the back table. We are taught that it is OUR sterile field to protect. I don't entirely agree with that. However, the surgeon(s) are frequently paying attention to the case and not everything else going on in the room (nurse, reps, anesthesia, med students trying to scratch their noses, etc) that we do end up watching the field like hawks and tend to jump on folks.

Now some folks are just A-holes and I got my hands slapped a lot when I was in training. Some of it just relates to giving folks a little bit of power and then going overboard.

Good etiquette in the OR goes a long way. When you enter the room introduce yourself. We freak out when we see faces we don't know. Don't get too close to the field and then ask the tech if you can get your gown and gloves. I have seen some seriously belligerent techs just leave students/residents waiting with wet hands if they have not opened gowns and gloves for themselves.

For those of you new to the OR, make sure you have shoe covers, cap and a mask before you enter the OR. It's embarrasing if you don't.

-Mike

 

[Blade28]

If you're watching us, who's watching you?

Quis custodiet ipsos custodes?

I've seen male attendings harass male med students/interns.

"No, that's not the urethra! Aren't you married? Is your wife happy? Is this the first time you've seen it with the lights on?"

It's actually amazing how many people (males and females) don't know which orifice to insert the Foley into when faced with a female patient. I've seen my fair share of med students trying to insert the Foley into the vaginal canal, under the clitoral hood, even into the anus! 😱

 

[Castro Viejo]

Quis custodiet ipsos custodes?

My thoughts exactly!

 

[Blade28]

My thoughts exactly!

👍 👍 Awesome that you got that reference. 🙂

 

[Castro Viejo]

👍 👍 Awesome that you got that reference. 🙂

The Satires. Juvenal?

Required reading for AP English when I was in high school.

Also somewhat loosely translated in the movie Superman when Lois Lane plummets down the side of some building in Metropolis and Superman catches her. "I've got you," he says. To which she replies, "If you've got me, then who's got you?"

 

[Blade28]

The Satires. Juvenal?

Required reading for AP English when I was in high school.

Holy mother of god, you're awesome! Yankee fan or not, you're A-okay in my book!

(Yes, it was Juvenal! I was a Latin minor in college.)

 

[Castro Viejo]

Holy mother of god, you're awesome! Yankee fan or not, you're A-okay in my book!

(Yes, it was Juvenal! I was a Latin minor in college.)

Oh snap! That's really cool!

 

[Blade28]

Oh snap! That's really cool!

BTW, how about that A-Rod crawling back to the Yankees with his tail between his legs?

 

[Castro Viejo]

BTW, how about that A-Rod crawling back to the Yankees with his tail between his legs?

He's a loser. I don't want him to come back, but would rather have that then have him go over to the Red Sux.

I wonder if this will mean he'll get rid of Scott Boras as his agent. That guy's a jerk. As much as I don't like the Sox, for them to announce the "I'm not coming back to New York" during Boston's win is just wrong. Plain wrong.

I totally love how the Steinbrenner brothers played this one. Smart. Really smart. They called his bluff and now he'll get a market or below market contract. Loser. It's great! I can't wait for opening day. I just know each of the 50,000+ fans at Yankee Stadium will be booing this guy.

"Mr. May!" "May Rod!" "Go-Away-Rod!" It'll be great!

Is Mike Lowell staying with the Sox?