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Notes from Your Attending

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INTRODUCTION

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First time in the OR, huh? Well, don’t touch anything. Just put your hands where I tell you to. You’re probably not going to understand anything we’re doing, so you can ask some questions when it’s a good time. As long as you read for the cases, you’ll be fine. Sit back and watch the master at work.

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Don’t mind him. It’s easy to lose sight of how overwhelming this place can be. To make things more difficult, every OR is a little bit different. We’ll try to give you some tips that will apply to most of them and get you off on the right foot for the others. The first tip, as you’ve probably already guessed, is that the operating theatre (to use an old-school and Very British term) is a very structured place, with a long list of rules (both published and unpublished), and it can be tense at times. One of the key roles of the attending surgeon (which some fill better than others) is to make sure the right level of tension is maintained; too much tension makes the team ineffective, while too little could lead to distraction.

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PREP BEFORE OR

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All right, so you think you are worthy of attempting to grace the hallowed halls of my operating room? Well, just know that I expect you to know EVERYTHING about the patient we are about to treat. I mean, shoe size, what they had for dinner two weeks ago, great-grandmother’s maiden name. EVERYTHING. However, don’t talk to me beforehand. Don’t make eye contact, as a matter of fact. Speak when spoken to, and softly at that.

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Okay, so this is a little extreme, don’t you think? It is true: most of us expect you to know as much about the patient as is feasible and appropriate. It is important for you to know why we are taking this particular patient to the OR, why we felt that an operation is what this person needed. Next, read about the operation itself. How is it performed? A brief review of a surgical atlas will help you understand what we are doing, keep you engaged during the surgery by knowing the anatomy and the steps, and will impress the heck out your attending. Know about the disease process that necessitates operative intervention. Know about alternative treatments and possible complications of the procedure. That said, we understand how incredibly hectic and tiring it can be as a medical student on their first surgery rotation. Two or three years ago, you were an undergraduate trying to schedule all of your classes to start no earlier than noon, and now you’re waking up at 4 a.m. to be the first to round on patients, and then running from time commitment to time commitment. Maybe you were assigned to scrub the case ...

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