The Dance

[GreatSaphenous]

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So I am currently on my pediatric surgery portion of my residency. Unfortunately my attending really likes to control the operation. My first week with him he actually pulled a dressing out of my hand so that he could apply it himself. Since then I have been more successful in getting to actually participate in the surgery, but in doing so I have been reminded how very much like a dance learning to operate really is. This is especially so in a program like mine where all of our attendings are private practice surgeons.

So what are your favorite "moves" that you use to really get the experience you crave?

Here's my top 3 (in descending order):

3. When an attending requests an instrument from the scrub nurse, I immediately reach for it first. (Even better learn to call for it just before he does)

2. Hiding as many instruments as possible in my hands while using others in the operation.

1. When stuck retracting, fumble enough that the attending adjusts the retractors. Then while he is stuck with the retractors in his hands let go and grab the Debakey's and mets and go to town. (Honestly, since part of being a good surgeon is being a good assistant, I would only recommend this very sparingly) 👍

I am the Great Saphenous!!!!!

Now go back to your noodle salad.

 

[sacrament]

You can't be serious.

 

[GreatSaphenous]

You can't be serious.

Not even remotely.

 

[Winged Scapula]

Getting to the room before the attending, and grabbing the knife while he's still scrubbing.

Obviously this only works with those attendings who aren't control freaks (as if there exists a surgeon who isn't), or those attendings you've worked with enough to know EXACTLY how they like things.

 

[Celiac Plexus]

There are attendings that will let you operate from the first case you scrub with them, and then there are attendings who won't let you lead until you have done many cases with them and they like your style, and then there attendings that will never allow anyone to do more than assist them. My feeling is that I can learn from all cases that I watch, or am scrubbed in on. Though I have more fun when I am the one calling the shots.

Just do what is expected of you, and try to learn from every operative encounter. I am in the camp that believes that you do not have to be the main player in a case in order to learn from it. I have learned to do most of my operative maneuvers from watching others do them first.

From an educational standpoint, I think it is more important to know what to do during an operation than actually being the one to do it. Instead of trying to take over a case from a domineering attending, focus on anticipating his/her moves, and position yourself to make the operation easy for him/her. When an attending breaks scrub at the end of the case, and says "That was fun!", you know you've done a good job. After a bunch of "fun" cases with you, the attending will be much more inclined to want to operate with you, and take the time to teach you how to do operate his/her way, and before long you will be leading and he/she will be making the case easy for you to do. Now that's fun.

 

[tussy]

Great Saphenous,

I think you're plans may backfire on you. Imagine yourself as the surgeon. You like to be in control of the surgery because you don't trust the resident to do it your way. So you get this new resident and operating with his is so annoying becuase its a constant battle to try and control the case, he hides instruments, hes a horrible retractor and if your not careful he dives in and starts dissecting stuff. Every time you ask the nurse for an instrument he dives in and takes it and starts trying to do stuff you don't want him to do... Can't you see how annoying that is? Now picture yourself as this surgeon; are you goign to let this annoying resident do anything?? Probably not.

A better plan is to realize that many surgeons like to stay in control of the situation and do things their way. It is their patient after all.

A better plan is to make yourself useful. Recognize that you are not goign to do the case and just pay attention to whats going on and be the best assisstant possible. Make the attending like operating with you because you're the best assistant. Eventually he might start letting you do more and more as a reward.

Other things that you can do to make yourself helpful:

Get to the OR earlier than the attending, position the patient the way he likes, scrub before him and get the patient all prepped to his specifications. Dont' start the case without him unless he gives you an indication that its okay (the last thing a control freak attending wants is someone that starts when he doesn't want you to).

Goodluck

 

[Winged Scapula]

I THINK GSV was joking in his orginal post (as is apparent from his later posts), but the suggestions are well-thought out.

 

[GreatSaphenous]

There have been some fine posts on surgical etiquette to be sure, but I should point out that the original post was a tongue-in-cheek statement that I scribbled down while on call.

Sure, I'll spin the Metzenbaum scissors around backwards so I can have them accessible and still wield another instrument, but the image of a resident with four or five instruments in his possession is pure hyperbole.

IMHO, gaining surgical experience is about depending upon your attendings experience, being prepared for the case, observing every detail, and participating as much as possible. Every good surgeon should first be a good assistant, but we also have to be assertive enough to not let the case just pass us by.

Now if anyone else has an off-the-wall suggestion, such as leaving a decoy set of pedals for the harmonic scapel on your attending's side of the table, then bring it on.

I am the Great Saphenous!

Back to your chicago-style deep dish.

 

[shag]

hmmm...

While doing laparoscopic cases, I load a video of a textbook case on the attending's monitor while I do the case.

The attending says "That was fun!" every time!

 

[tussy]

Okay - no more posting for me before my morning coffee. I actually thought you were serious. I've actually seen residents trying to pull some of those things you suggested though.

I'm relieved that you weren't serious.

 

[Dr JPH]

Now if anyone else has an off-the-wall suggestion, such as leaving a decoy set of pedals for the harmonic scapel on your attending's side of the table, then bring it on.

👍

 

[Tigger14]

One of our attendings has a new interest in YouTube, and the circulator routinely has funny snippets. The surgeon already let me do most of the cases with him, but now he frequently is over at the computer monitor.

 

[DNASplicer]

From an educational standpoint, I think it is more important to know what to do during an operation than actually being the one to do it. Instead of trying to take over a case from a domineering attending, focus on anticipating his/her moves, and position yourself to make the operation easy for him/her. When an attending breaks scrub at the end of the case, and says "That was fun!", you know you've done a good job. After a bunch of "fun" cases with you, the attending will be much more inclined to want to operate with you, and take the time to teach you how to do operate his/her way, and before long you will be leading and he/she will be making the case easy for you to do. Now that's fun.[/QUOTE]

From a vascular attending, her advice was to understand what the steps of each surgical case are and then learn how to anticipate. She suggested the book Mastery of Surgery.

Do you have any other suggestions , b/c that's what I am all about... Mastery of Surgery (realize I say this as a pre-intern...) 😉