Most of these “dos” are simple things that are both helpful and are easy to do. In other words, they don’t take any brain power away from the one million Anki cards you have stored. Tying Gowns Often, you will find yourself in the OR and you won’t be sterile (scrubbed) while others are gowning up. If this is the case, tie their gown for them. There is a Velcro strap that goes around the back of the neck, and two tie strings that are located at the hips. Also, the person you just tied might turn around and hand you a card that is attached to their gown... just hold it and watch them spin. Get the Bed/Help Move the Patient After every case, the patient will be moved from the surgery table to a hospital bed. Once the case is over, and anesthesia has extubated, go get the hospital bed. It is located outside the OR door. Wheel that puppy in, and get ready to help move the patient. But first, in every OR, there is a blue “transfer board”, find it. If you’ve never transferred a patient before, I would recommend starting with helping stabilize the feet, but pay attention to the people with the board because in a couple days you can help with that. Be Attentive, Always If you find a physician more attentive to detail than a surgeon, then you have found an infectious disease doc taking an HPI, other than that... there are none. Attentive people like attentive people. That’s obvious, right? When you are in the OR, this is a great time to pay attention to all the details, and not just within the surgery. For example, after a case had been going on for a while, a classmate of mine noticed that the ALP® compression sleeves (DVT prevention) weren’t on... he promptly let someone know and the attending was very impressed with his attention to detail and even wrote about this in his evaluation. In the OR, there are always ways to be helpful, but if you’re not paying attention, you will miss some opportunities. Know the Anatomy or at Least Know Something Okay, this one might take up a little bit of brainspace... but you can handle it. I would say 90% of “pimp” questions in the OR are about anatomy. Therefore, know it. Now, there will be plenty of times that someone points to something and asks “what is this?” and you will have no idea. This is where the “know something” part comes in. Even if you don’t know what they are pointing to, you should know something they MIGHT be pointing to. For instance, during a cholecystectomy, the surgeon will locate both the cystic duct and the cystic artery and will likely ask you about one or both. In case you were wondering, their anatomical next-door neighbors. So, if they point and ask “what is this?” and you only see shades of red, you could say something like “well, I know around this point we should be ligating either the cystic duct or cystic artery... I’m not sure which one that is but I would say it’s one of those.” This is both correct(ish) and shows you’ve reviewed the relevant anatomy. However, if you know the answer, say it confidently. Be Helpful, but Not Dangerous This one involves a lot of doing with a dash of don’ting. One of the first cases that I scrubbed into, as I was standing at the table, the attending told me his rule for medical students: “If you feel like you can be helpful, please do, but don’t mess up.” As med students, we do a lot of suture cutting and retracting. What do both things have in common, you ask? They’re impossible to mess up... well... mostly impossible. For example, most the time it is obvious what suture the attending/resident is wanting to be cut, however, not every suture that has been passed/tied needs to be cut at the moment. So, how do we know what to do when? Sometimes you don’t, and it’s okay to ask. That said, there is an opportunity to impress in these moments. Paying close attention (shout out to “Be Attentive. Always”) to the previous steps of the procedure will allow you to see they OFTEN are repetitive. Paying attention will allow you to anticipate what you can do next to be helpful (ie what suture to cut and where to move the retractor). Now, there is still a fine line to walk between being helpful and hurtful. Please don’t mess up. You DO NOT want to cut a suture that isn’t supposed to be cut. Again, be helpful, but don’t mess up, and always ask if you’re unsure.

This section is shorter, but more important. Just like a Catholic wedding, there are plenty of things you can do, but if you don’t, most people won’t notice. However, there are a few things that you should not do, but if you do, EVERYONE will notice. Don’t Break the Sterile Field This is the obvious one. It’s obvious for a reason. I will say, however, the subheading is a little harsh. It’s okay if you break sterile field once or twice. It is not okay to make a habit of this. If you break sterile field once in a case and must rescrub, don’t break it again. A simple way to help with this is let the scrub nurses/techs know that this is your first couple times in an OR and they will guide you. If you are asked to rescrub, just do it with grace and get back in there. Don’t Ask Stupid Questions at Stupid Times “No question is a stupid question” is mostly true, but even the best question asked at a stupid time is a stupid question. Period. Hear me out. If the attending has stepped in to relieve the resident during a key moment, that’s a bad time to ask a question. If the attending and resident haven’t talked in the past 30 minutes, that’s a bad time. If the attending/resident has talked but >50% of the words have been curse words... also a bad time. For the most part, it’s obvious when to and when not to ask a question. Please take the intensity of the situation into account when you are asking questions. I’ve heard of attendings asking students to stop talking because of their question timing. Have some feel, and if you can’t tell if it’s a good time or not... it’s not. Don’t Fall Asleep This one needs no explanation. Do not fall asleep. Yes, there will be times when you have been standing in place for two hours and you can’t even see the surgical field because there are too many people scrubbed. You will begin to wonder if it’s possible to sleep standing up. It is. But, you must do whatever it takes to not fall asleep. Believe me, there is no sweeter lullaby than the heart monitor beeping in a dim lit room during a laparoscopic case. Fight the urge. My conclusion is simple. There is a lot of things you can and should do in the OR to be helpful/standout. There are a few things you can do in the OR to be hurtful/standout in a negative way. Do your best to maximize the Dos and make the Don’ts obsolete.