10 Things that Pre-Meds Should Know About Shadowing in the O.R.

Shadowing as a pre-med is scary enough. But shadowing in the operating room takes the game to a whole new level. Not only are you seeing real-life surgery, but you are also seeing people at their most vulnerable moments. The moments where they are completely helpless and dependent on strangers to keep them safe and perform surgeries that will fix their injuries and ailments. This is an area that can be utterly terrifying as a pre-med. The personalities in the operating room are unique and intimidating. With the tips below, we hope to make your experience in the operating room more comfortable and memorable. Being a surgeon is a career that comes with its challenges but also comes with the power to change or save people’s lives.

1. Eat a good breakfast

This seems like an elementary thing to put on the list but it is very important. Days in the OR can be very long and hectic. It is not uncommon for a surgeon to go all day without eating. To prepare for this make sure to eat a good breakfast before you come in and pack a few protein or granola bars that you can stick in your pocket. Be sure you are not in the OR or in the sub-sterile area when you eat your snack. The last thing you want is to be miserable during the day because you are starving.

Drink plenty of fluids and take advantage of the bathroom between cases. It is easy to get dehydrated during long surgery days so be sure to drink plenty of water throughout the day. You can often find water in the patient holding areas such as the pre-op or post-anesthesia areas.  Don’t be afraid to ask a nurse where water dispenser is. It is typically not recommended to drink tap water in the hospital but rather find the filtered water dispenser.

2.    Dress for success

I typically recommend coming to the hospital in business casual attire because you never know who is going to see you walking through the waiting room or the parking lot. Be mindful of what shoes you wear, even though you want to look good walking in remember you are going to be on your feet ALL day so you do want to wear somewhat comfortable shoes.  Plus, you don’t want your expensive dress shoes getting ruined with some of the things that you may come in contact with in the OR.

Once you have found the locker room you will have to change into scrubs. These are specific colors for each hospital and you are required to change into and out of the hospital laundered scrubs at the beginning/end of each day. This is to help prevent bugs from the outside getting into the hospital and also to prevent you from taking bugs home from the hospital to your family.

Once you have got your scrubs on the next thing you need to find in a hair cover or surgeons cap. Everyone, whether they have hair or not, has to have a cap or hair cover. The next piece of attire is shoe covers because you are likely wearing shoes that have been exposed to the world outside the OR you will need to wear disposable covers to prevent germs/bugs from being tracked into the sterile environment. Furthermore, you want to protect your sneakers from getting blood or other fluids on them. You will see a lot of staff do not wear shoe covers but this is because they have shoes that never leave the OR. Grab eye protection before each case, each OR room typically has a handful of disposable glasses that can keep you from getting body fluids in your eyes (it happens). If you wear glasses those should suffice to keep you protected.

The operating room is a cold place with temperatures usually kept between 65 – 70 degrees. If you are someone that gets cold you can ask the nurse for a warm blanket or an OR jacket. Some hospitals will allow you to wear a long-sleeved shirt under your scrubs but this can vary from place to place so you should ask when you get there if this is acceptable.

If you see that the portable x-ray machine is in the room or you are told that x-ray will be used then you will need to find a lead apron or vest/skirt and a thyroid shield to wear during the surgery. The staff in the room can be very helpful when you are looking for these.

Keep your personal items to the bare minimum. Scrub pockets are very limited. Most only have a front left chest pocket and one back pant pocket. You will not be allowed to haul a purse or bag around with you in the operating room. If you bring valuables know that they may be stored in an unlocked locker all day. You can keep your phone and your wallet in your scrub pocket if they aren’t too big, but you don’t want to be lugging a bunch of stuff around with you all day.

3.    Understand the Hierarchy

While the surgeon seems like the ultimate power in the operating room, know that they have earned respect through years of training and working at a hospital. For the young pre-med this can be an intimidating an unforgiving environment. Learning the roles of the various people in the O.R. will help you successfully navigate this unique workplace.  There will be multiple people that you will need to work with to make this an enjoyable experience.

The first step when you walk into the building is to introduce yourself to the staff. When you are shadowing as a pre-med you should walk up to the front O.R. desk and ask to speak to the “Charge Nurse” this person is the individual in charge of the majority of personnel in the operating room, they are the boss and responsible for any problems in the O.R.  The charge nurse is usually by the main O.R. desk and should know when there is a visitor. Don’t be discouraged if you get an unenthusiastic greeting from this person or the desk staff. These are very busy individuals and have a lot on their plate.

The circulating nurse is the person responsible for each O.R. they are the person that verifies that everything is running smoothly and as safe as possible. The surgical tech is the person responsible for assuring that all tools and equipment are available for each particular case. They also assist with each surgery passing instruments or helping the surgeon directly.

The person at the head of the bed is either the anesthesiologist or the CRNA (nurse anesthetist) these providers are responsible for providing anesthesia and keeping the patient comfortable during the procedure. The anesthesiologist is in charge of the CRNA but often oversees most of the rooms, they will be there for the beginning of the case or if the CRNA has any issues. The CRNA runs the anesthesia during the remainder of the case and monitors the patient. The anesthesia teams first job is the safety of the patient, so be mindful if they are giving directions. At the beginning of each case they will be putting the patient to sleep and intubating the patient. This is a critical moment during the case and the room should be quiet and focused.

4.    Introduce yourself

When you walk into the O.R. room that the surgeon you are shadowing will be working, find the circulating nurse and introduce yourself. It is perfectly acceptable to walk into an O.R. and say “Hi my name is … I am here to shadow Dr. …, who is the circulating nurse today? This will show the entire staff that you know how the system works. The circulating nurse is the person responsible for all the staff in each particular O.R. they have to keep a record of every person that was in the room for each procedure. Since you are new to the team it is a nice gesture to write your name down for the circulating nurse. Usually the best place to do this is on the white board in the O.R. but it is always safe to ask where they want you to write your name. The circulating nurse can be your best friend and can help you look good during your shadowing experience. They have known the surgeons for a very long time and know the intricacies of what they like and dislike.

5.    NEVER touch the blue stuff!!!

In the O.R. nothing is more sacred than the sterile field! Infection is the nemesis of surgery and we do our very best to prevent infection with every operation. The core dogma to preventing infection is maintaining a sterile field. To do this every surgery is prepped and draped in a very particular fashion. Most if not all operating rooms use blue drapes to signify the sterile or “DO NOT TOUCH” areas. While almost everything is blue, occasionally clear plastic or green drapes are used. If something looks like it has been covered on or near the patient or equipment just assume you should not touch it.

As a pre-med shadowing, it is your responsibility to stay several feet away from the sterile field. Don’t be offended when the staff reminds you of this. The surgical tech will likely, not so gentility, remind you if you get too close to their sterile field. If you contaminate a procedure it can cause serious complications or significant delays in a procedure. Be VERY cognizant of the sterile field and stay well away from the blue stuff. If you aren’t sure you can ask the circulating nurse or the scrub tech for clarification and they will be more than happy to teach you. 

When you are moving around in the operating room you should avoid walking between two sterile objects and keep around 3 feet of space between you and a sterile field. You may see seasoned OR staff break these rules, but as the new person in the room, you will be expected to abide by them. For example, you should avoid walking between the surgical instrument table and a prepped and draped patient. You should also avoid walking between the surgeon or surgical tech and the sterile field once they have scrubbed in.      

6.    Don’t pass out

The operating room is filled with new sights and smells. Every person responds differently to this and it is something you likely haven’t experienced before. Sometimes, these new sights and smells can cause even the strongest people to become nauseous, light-headed, or even pass out. It is VERY important that if you are feeling any of these symptoms to tell the circulating nurses so they can help you.

If you feel like you are going to pass out, find the nearest chair or even sit down on the floor. The worst thing you can do is try and tough it out and pass out while standing up. This would be very dangerous for you AND the patient. In this situation, it is better to ask for help than risk getting hurt or causing a complication. This is nothing to be ashamed of and you should not hesitate to tell someone if you are not doing okay.

7.    Don’t sit down

While it seems silly to tell people to not sit down during a procedure it is something that is usually expected of pre-meds, medical students, and residents. While every surgeon is different in his or her expectations it is always safe to assume that you should be standing for the operation to show your interest. With that being said and discussed above if you aren’t feeling well or feel like you are going to pass out you should immediately sit down or leave the room. No one will fault you if you are not feeling well. 

8.    Know when to ask questions

While it is encouraged to ask questions and be engaged while shadowing in the operating room. There are times when all the staff and the surgeon are relaxed and joking around and there are times when everyone is quiet and concentrated. During times of high stress in the room, it is best to be quiet and just observe.

The safest time to ask questions is at the end of the case when the surgeon is closing the wound. This is generally a time when all the critical parts of the case have been completed and attention is safe to be directed toward questions. Another time to ask questions to the surgeon is between cases when you are waiting for the room to be cleaned and ready for the next patient. Surgeons typically have some downtime during this point and can teach.

Once you have spent time in the operating room you will be able to tell when things are going well and the surgeon can answer questions during the case, don’t be offended if you ask a question and you don’t get a response right away. The surgeon is likely just concentrating on the procedure and needs to answer your question later. Don’t be afraid to ask again after the surgery if you did not get a response.

9.    Know when to help

As a pre-med student, you have very little ability to help during surgery. You will not be able to scrub into a case and you probably won’t be allowed to touch the patient because of medical-legal risks.  However, there are a couple of small tasks that you can help with. 

Help take the bed in and out of the room. Each patient will be transported to the operating room on a hospital bed or gurney and moved onto the OR table. Once the patient has been moved onto the table it is very helpful when someone takes the bed out into the hallway. When the operation is done and the surgical drapes are being taken down you can bring the bed back into the room. Just be sure that you bring in the correct patient bed, it is usually the one parked right next to the O.R. door that you are in but it is always safe to verify if confused. You don’t want to put a patient onto a used hospital bed.  Try and figure out which is the head side and feet side of the bed and bring it into the room in the appropriate orientation. The head of the bed usually has handles and a pillow but this can differ with different types Don’t worry if you accidentally bring it into the room the wrong direction and have to take it out to reposition it, everyone has done this multiple times. 

Get warm blankets for patients. This is an easy way to help out, find the blanket warmer closest to the operating room you are working in and at the beginning and end of each case bring two warm clean blankets to each patient for the nurse to put on.

Help pick up trash at the end of the case. After each surgery is completed there is a scramble to get the room cleaned up and ready for the next patient. You can help tidy up the room by picking up trash and linens off the floor and putting them in the appropriate waste or laundry baskets. You can also offer to help wipe down equipment but some OR staff may not want you to help with this so just make sure you ask before you jump on this task.

10.    Fake it ‘till you make it

If confidence is important anywhere it is important in the operating room. As a pre-med, you may feel like you are the bottom of the totem pole but realize that everyone had to start at your level or below. The operating room is unique in that the staff can tell if you are nervous and feel out of place. While some will be welcoming others will make you feel like you don’t belong. Show confidence being there and be proud to be pursuing such a noble field. The pure act of confidence will take you a long way in this arena.  

Summary

Working in the operating room is a tremendous privilege. You are trusted to take care of patients at their most vulnerable times and the operating room team is dedicated to making each case run as smoothly and safely as possible. Most people who have worked in the OR have done so for many years and have a special bond with their coworkers. This is a special place where emotions can run high and stress can be overwhelming but what we do for patients here is truly amazing.

I hope that with these tips you will have a good experience shadowing in the operating room and find that this is an amazing place to work.

Clay Dorenkamp, D.O

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