surgeons, using the latest in cutting edge surgical technology to save lives? You've

seen it on TV shows, but perhaps never stepped in the OR yourself. It seems mysterious, intense,

even a little intimidating. Here's what to expect when you first enter the operating

room. Dr. Jubbal, MedSchoolInsiders.com.

For many medical students and aspiring surgeons, the first time you enter the operating room

will be in your third year, during your clerkship rotations. The common theme of your third

year of medical school is that you want to learn, be helpful, and not get in the way.

This is most apparent in the operating room, where it's difficult to help and easy to get

in the way. When you enter the operating room, always

introduce yourself, and usually it's best practice to write your name on the whiteboard.

This is because the circulating nurse needs to chart in the computer who all was in the

room. Do your best to not get in the way. Your first

few times in the OR, you may be confused by all the moving pieces. That's fine, as long

as you don't slow other people down in doing their job.

Avoid being on your phone. Even if you're trying to be useful or studious, it looks

like you're texting and not paying attention. Surgery is often high stress, and there will

be moments of high tension where you may be yelled at or not like how someone talks to

you. Don't beat yourself up, and don't take it personally. It's more often a reflection

of the situation or the character of the individual, and surgery tends to have a higher proportion

of more abrasive personality types. Your aim as a medical trainee is to learn,

and you should be asking questions, but timing is critical. You don't want to be the annoying

student that asks too many questions, and you also don't want to be the student who

asks questions at inappropriate moments. During times of high stress and tension, refrain

from asking questions and allow the various members of the surgical team to resolve the

situation. The more you work with a particular surgeon and other members of the surgical

team, the more you'll get a feeling for what is and is not appropriate. Timing is important,

as you don't want to interrupt their focus during moments of higher acuity.

It's also viewed favorably by all members of the surgical team when you firmly, but

with surgical precision, press on both the like and subscribe buttons of this video.

Not too hard as to cause unnecessary tissue damage, and not too gently, otherwise it's

as if no intervention ever occurred. The single most important thing is that you

don't contaminate the sterile field. Doing so won't make you any friends.

The purpose of creating a sterile field around the surgical site is to reduce the number

of microbes and therefore the risk of infection and complications.

How do they decide where to draw the line on sterility? Well, making the whole operating

room sterile isn't practical, nor does it confer improved infection risk. On the other

hand, sterilizing only the immediate area of the incision would still introduce microbes

from movement and touching surrounding unsterilized structures.

For this reason, the sterile field generally includes the drapes over the patient, down

to about your waist height. If you're scrubbed in, meaning you are wearing a surgical gown

and gloves, then your hands and arms, and anterior torso from your chest down to your

waist are in the sterile field too. If a sterile object makes contact with a non-sterile

object, we call that contaminating the sterile field. If your nose is itchy and you're scrubbed

in, too bad, as touching it will contaminate the sterile field. You'll have to wait for

it to pass, as touching your face, glasses, mask, or anything that isn't sterile is a

big no-no. If your mask is fogging up or you're having issues seeing, then ask one of the

nurses who isn't scrubbed in to help make adjustments.

Standing by the operating table, your hands should either be resting on the drapes on

top of the patient, or you should hold your hands in front of you. Do not drop your hands

below your waist or to your sides, as doing so would contaminate them.

If you're going to sneeze and you're standing at the sterile field, then take a step or

two back and sneeze directly into your mask, facing toward the sterile field. Do not raise

your arm to cover your mouth, as that would contaminate your sterile sleeves, and do not

turn to the sides, as doing so will allow microbes to escape from the sides of your

mask and toward the surgical field. The first time you're in the operating room,

you likely won't be scrubbed in, meaning you'll just be wearing regular scrubs and no part

of you will be considered sterile. In this case, you always want to maintain a safe distance

from the sterile field as to not contaminate it.

Surgery is still very much an old boys' club, and even as a student there will be several

unspoken expectations of you, and you should always come prepared.

If it's your first time and you're not scrubbing in, still make sure you wear a mask and eye

protection. Everyone inside the operating room must wear a mask to reduce airborne microbes,

and once you see fluids squirt around, you'll understand why eye protection is paramount.

If you are scrubbing in, make sure you know proper scrub technique and follow it closely.

To reduce interruptions, use the bathroom prior to entering the surgical suite. It's

generally frowned upon to excuse yourself to use the bathroom, particularly if you're

scrubbed in, and even more so if it's a shorter case. It shows you simply weren't prepared.

You should also avoid chugging a gallon of water right before surgery for obvious reasons.

In line with reducing interruptions, put your phone on silent or vibrate, as you don't want

to distract the surgeon while your Drake ringtone blasts at max volume.

Complications and unexpected delays in the operating room are common, and you should

be prepared to stick around longer than expected. No food is allowed in the operating room,

so be sure to fuel yourself ahead of time. If you're a medical student rotating on the

surgical service, be ready to be pimped, meaning quizzed by your residents or attending. You

should absolutely know the patient, why the surgery is indicated, the nature of the surgery,

the anatomy you'll be seeing intraoperatively, and other relevant details. Expectations will

vary depending on your stage in training and whether or not you're pursuing a surgical

specialty for residency. A third year medical student on their first day in the OR will

have different expectations than a fourth year who is doing a plastic surgery sub-internship

and hoping to match into the field. After a few cases in the OR, you should start

to form an understanding of how things work. The room is prepared, the patient is rolled

in, anesthesia begun, time out is performed, and the first incision is made. After the

incision is closed, the site is properly bandaged or dressed, the patient is woken up and extubated,

transferred to a hospital bed, and wheeled out to post-op.

Depending on whether or not you're scrubbed in, there will be different tasks you can

help with. By being attentive and observant, it won't be difficult to figure out where

to be useful. If you're not scrubbed in, you can help the

patient get transferred to the operating room table, grab supplies from the back supply

room, help gown others who are scrubbing in, pull up imaging on the TV screen if the surgeon

needs to reference something while operating, and anything else you're asked of. After closing,

you can grab the gurney, which is usually outside the room, transfer the patient, and

so on. If you are scrubbed in, do your best to not

get in the way, don't contaminate the sterile field, and get great at retracting, since

you'll be doing a lot of it. Retracting is when you help hold back organs or tissues,

usually with one of many tools, allowing the surgeon to more easily view and operate on

the exposed area. You may need to suction, apply pressure, cut sutures, and do other

minor tasks too. By first demonstrating proficiency in these basic tasks, you'll then be allowed

to close, meaning suture the incision, and even do other simple techniques with the scalpel

or bovie. Also understand that each surgeon will have

different preferences. Some will appreciate you helping to drape the patient, while others

are more particular and would prefer you stay out of the way. When it comes to cutting suture,

if you cut the tails too long, then there's excess material in the patient which can lead

to inflammation and increased risk of infection. If you cut the tails too short, then there's

a higher risk of the knot failing. The running joke amongst medical students is that you'll

always cut too long or too short, but never just right. That's fine, just do your best

to learn the surgeon's preferences and take all feedback in stride.

If you found anything in this video helpful, let me know with a thumbs up and if you want

to see more like this, tap that subscribe button firmly and with surgical precision.

If you enjoyed this, check out my video explaining the various members of the surgical team.

And if you want me to cover something else about surgery or the operating room, let me

know with a comment down below. Much love, and I'll see you guys there.