The operating room is a profoundly rich learning environment for students when faculty and staff take simple steps to help students navigate through their initial sense of intimidation and disorientation, while setting some basic expectations for learning and preparation.
Preparing for the Case
While a surgical resident can be directed to "read about the case" or "review the procedure" the night before, a medical student will benefit from more specific direction, such as "read about the muscles and vasculature of the anterior abdominal wall" or "review the course of the ureter in the pelvis." When possible, they should read or review a video prior to the case, which at least begins at their level. FIU students are given links to several websites with surgical videos. Let them know of any you strongly recommend for early learners - ones that break cases into the major steps with reference to the most relevant aspects of anatomy for that case.
Students should of course know the patient when possible, and if not, know the key details of the case. Especially since the emphasis for third-year learning is diagnosis, it is important for them to understand how the patient’s surgical disease presented, the differential diagnosis for that presentation and the work-up for that presentation.
Regarding informed consent, you can help the student understand:
- What is it that the patient needs to make the right decision?
- How do you know if someone really understands the risks and indications?
- Here is what I do to understand the situation from the patient’s point of view . . .
- Here is how I deal with my biases . . .
- Here is what I do to mediate when the family disagrees over care . . .
In the Operating Room
Especially the first few times in the operating room, and the first time with a new attending, students need communication and cues. Let them know:
- If they will scrub or just observe
- Where they should stand
- What they will/might do (i.e., place a foley, close skin, put on a tenaculum)
- When they might get to see the operative field on open cases
Use anatomical terms to describe location.
It is also important to remember that when instructing students in instrument, retractor, and suture placement and movement, terms like "up" and "down", or "here" or "there", can be very confusing. They are usually better replaced with anatomical terms (e.g., anterior abdominal wall, caudad, the patient’s right side).
Use ancillary staff
Students can learn from others in the OR as well. Spending a portion of the case with a scrub nurse who names the instruments as they are passed, while offering a basic description of how that instrument will be used, may be a better learning experience than simply retracting in a field that they cannot see.
Remember the power of narration.
Explaining both what you are doing and why you are doing it, will turn for many students a bewildering and passive experience into a goldmine of learning by observation.
Let the students know.
Students need to hear both what they are doing well ("You cut the structure the correct length") and what they need to correct ("You need to close the instrument completely").
This diagram on teaching medical procedures is from an article from the New England Journal of Medicine geared towards residents who teach and applicable to any medical educator. Read the article, The Resident as Teacher.
This article from the American College of Surgeons describes "Employ a Structured Approach to Teaching Psychomotor Skills to Enhance Learner Performance"
This 2 ½ page article is from the Association of Professors of Gynecology and Obstetrics and describes "Effective Operating Room Teaching"