Download Instructor's Guide (.pdf)Operative Teaching Outline
- General teaching points
- Early involvement of the medical student
- Continuous participation
- Post-operative follow up
- Pre-operative teaching
- Introduce yourself to the medical student
- Be casual
- Be friendly
- Be energetic
- Enlist the student’s early participation
- Interest is infectious
- Verbally invite student to participate in operating room case
- Do not assume student knows where to go
- Do not assume student knows “how” to participate
- Introduce student to other medical team members
- Remember, you are now the student’s “advocate”
- Introduce student to patient
- Introduce as “medical student”
- Encourage student to talk to patient
- Have student listen to patient counseling about what to expect in operating room and afterwards
- Discuss examination under anesthesia with student and patient and include in consent
- Go through patient chart with student
- Review pre-operative history and physical
- Presenting complaints
- Physical exam
- Lab tests
- Plan
- Review pre-operative labs with student
- Explain consent form
- Briefly explain surgical plan
- Verbally explain operative technique and draw pictures
- Paper towels over scrub sinks make great teaching tools
- Explain procedure step by step
- Encourage student to ask to do things in operating room (examples: open abdomen and help close fascia)
- Shows student interest
- The worst thing that can happen is an answer of “no”
- Makes student pay attention during surgery
- Can have a profound impact on what student remembers about a case
- Operative experience a necessary part of medical education – surgery is a learned skill
- Can influence career choices – students tend to go into the fields where they got the most experience
- Student can help transport patient to operating room
- Teaching in operating room
- Introduce student to operating room staff
- Tell student to help get patient on table
- Help student remove cart from room
- Explain patient positioning
- Stirrups
- Arms
- Student can help place pneumoboots
- Have student pull own gloves
- Ask student questions about the disease process to assess fund of knowledge
- The point is not to make the student sweat
- Purpose is to teach student about disease and its management
- Have student examine patient after anesthesia administered
- Show student how to prep patient
- This is an often overlooked, but very important, surgical principle
- Scrub with student
- Show student how to drape patient
- Show student where to stand
- Verbally explain steps of surgery as they are happening
- Helpful tips
- How to hold needle driver
- Tying knots
- How to deal with troublesome bleeding
- How to check for operative injury
- Have student perform small tasks along the way
- Inserting foley catheter
- Hold clamps and retractors
- Removing clamps as necessary
- Stop at appropriate points during case to point out anatomy or have student feel what primary surgeon is feeling
- Have student help with closure, packing, etc.
- Have student help take drapes down
- Post-operative
- Have student “dictate” orders as you write them
- Use mnemonics: ADCVANDISML
- Have student “dictate” operative note as you write it
- Use mnemonics: PPPAAA, fluids x 3 (IVF, EBL, UOP), other x 3 (specimens, complications, findings)
- Have student help move patient
- Have student keep sticker with patient summary
- They will be seeing patient in the morning
- Have the student listen to your operative dictation
- Reinforces surgery they just saw
- Provides guidance about how to dictate – another learned medical skill
- Tell student where to find patient for rounds in the morning and what time they should see patient
- Tell student what they can and should do in the morning
- Remove wound packings
- Remove bandages
- Encourage student to write orders on a new order sheet -- they can always be changed
- Briefly explain post-operative routines (ambulation, advancing diet, etc.)
- Students should not put charts in the “Doctor’s Orders” slots
- Review what the student learned
- What questions does the student have?
- Give the student “homework” to work on skills
- Example: make a bracelet from sutures using two-handed knots, then one-handed knots (each side)
- If possible, have student read the transcribed dictation and review the surgery with you in their own words