The operating theatre is a great place to learn more about surgery, with plenty of pathologies, skills and communication on show. It is an exciting and busy place to learn but can also be daunting for those heading to theatres for the first time. We have compiled some advice below to hopefully answer some FAQs and help you to get the most out of the experience!
Getting into theatre
Ask the consultant whether he/she would be happy for you to join him/her, preferably the day before. If you want to scrub then this is a good time to ask. They may say “actually there will be a couple registrars, so no”. Hearing this can often be a mental blow, but it is important to remember that having registrars means there is likely to be less space at the table and even if you did scrub in, there wouldn’t be much for you to do aside from observe.
Find the theatre list for the day you’ll be going into theatre so you can get an idea of what you’ll be seeing – best place to go is the consultant’s secretary. Some wards will have a list behind the nurses station. A friendly FY1/2 may be able to look up the list on the computer system. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Most consultants like to ask questions during surgery so it is good to have some ready knowledge.
Operating lists start at different times. Find out when from the consultant/registrar/ theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone is introduced, especially at the WHO checklist. You will also be able to introduce yourself to the patient and observe, or even get involved with their anaesthetic preparation. It is better to be a bit early and wait rather than late and miss out.
In the morning
Make sure you have a good breakfast – there is nothing worse than feeling sick if scrubbed into a warm room for a long surgery.
Get changed into scrubs and put on a white theatre cap (indicates that you are a student – different trusts may have different colours). Change into clogs or put blue shoe covers over your work shoes (can found by the theatre caps). Take off all jewellery and tie/tuck any long hair into your cap. At all times make sure your ID is visible. In general, for theatre changing rooms it is best to bring your valuables with you, or simply don’t bring valuables to a theatre day. There is often a staff room close to the operating theatres wear a bag could be left.
In the operating room
Hopefully you will have met the consultant before. Say “Hi” anyway. You’ll be surprised how often they don’t remember or notice you, even though you think they have seen you. Get in on the team introductions and make sure the team know you are a medical student. Find out who the anaesthetist is and introduce yourself to them. The anaesthetist will have a good idea of what is happening in the operation and is a great person to learn from, especially when the surgeon is busy operating. It can be daunting to approach the surgeons, especially if you haven’t been introduced before, but if they look like they could have 2 mins to spare for introductions then take the opportunity. It is also a great time to ask if you could scrub in.
Simple rules of theatre
• Don’t touch anything green/blue in the operating room especially on tables/trolleys
• Do not touch the surgeons after they are gowned and gloved as they are now sterile – maintain good dodging skills until they have gotten to their place at the table
• If a lanyard may get in the way, then tuck your ID badge into your scrub top
• Masks must be worn at all times once the instruments have been opened
• If you plan to scrub in you must wear eye protection
• Be prepared to help out if asked to do so but never take or use an instrument without being directed – keep safe
• If scrubbed, do not touch anything non-sterile, keep your hands around chest height and close to your body – avoid your face and going below the waist.
• Sit down and have a drink of water if you are going to faint – it happens to everyone, just let someone know
Who is who?
Usually there will be 3 people scrubbed in and working on the patient. It will usually be a consultant surgeon, a registrar, and a scrub nurse. The scrub nurse stands next to the consultant and passes equipment to him/her. The assistant (usually registrar) stands on the opposite side. The consultant anaesthetist is at the head of the patient. There will be other nurses around in case the scrub nurse needs more equipment, and also technicians to set up the operating table and position the patient at the beginning and end.
How to see
If it is open surgery you may need a pedestal to see over the surgeon’s shoulders. Let them know you are standing behind them so they don’t bump into you if they stand up.
If it is laparoscopic surgery there will be a TV screen so you don’t need to be standing as close to the surgeons.
Getting the most
Not scrubbed: when you’re standing for a long time just keep your legs moving so you don’t faint. If nothing interesting is happening go talk to the anaesthetist. Ask him/her about the machines and what they are doing.
Scrubbed: get involved with assisting. Follow instructions carefully and clarify if you are not sure what you are being asked to do. Make sure you understand what the surgeons are doing and why. Ask to see/feel anatomy and pathology.
The surgeons will be more than happy to answer questions/teach you while doing things that are technically simple and routine to them eg. prepping the patient, opening the patient, closing the patient. You will be able to tell when they don’t need to focus as much as usually they will start talking about their plans for the weekend etc.
At the end
When the surgery is finished you can make yourself useful by helping the theatre staff with moving the patient. You will be taught how to slide patients from the operating table onto a ward bed in Manual Handling.
Stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Get a drink. At times you will have to wait extensively for the next operation. This is also the time to disappear if you would like to, just make sure you thank the team.
Hopefully this gives you a better idea what to expect when going to theatre for the first time. Enjoy your time in theatre and hopefully you will see lots of very cool things. Be prepared to ask and get involved and the more you see and do, the more you will get out of it!
If you’re unsure about anything, just ask a theatre staff or get in touch with us at Surgsoc.