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