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Making the Most of Theatre Time

As a trainee, your limited working hours mean you need to squeeze every drop of educational value from every encounter in the operating theatre. Although simulation has a role to play in learning how to operate, real experience is needed for you to appreciate variations in anatomy, to make intraoperative decisions, and to use technical skills in a challenging environment.

This is even more difficult with the current reduction in “trainer continuity.” The surgical registrar whom you impressed last week is probably not going to be the same one who you hope will let you do the next case. So how can you break this barrier time and time again to get the experience you need? Here is a step by step guide.

Step 1: Anticipate and be available

The early bird catches the worm. Anticipate the activities of all the firms that interest you, not just your own. Know who will be operating and whether there will be an assistant or trainee present already—registrar leave or absence could yield excellent consultant led training opportunities. Present yourself, offer to help, and don’t be shy. Bear in mind, however, that because you have your own patients to look after you may be called away at a second’s notice. Prioritise your commitments, but remember: theatre cases will never wait for you.

Each morning scavenge the emergency theatre list, write your bleep on it, and tell the on-call registrar that you want to scrub. Be helpful—offer to send the blood “group and save,” ensure that consent procedure is complete, or even offer to see a patient in the accident and emergency department if you have time. You are more likely to be taught and given “cutting time” if you help foster the team spirit.

Step 2: Read around

You cannot expect to be given the scalpel if you are not crystal clear about the relevant anatomy, pathology, and steps of the operation. Armed with knowledge, your cutting experience will improve, as you reinforce all that you have read. Refamiliarise yourself: the Oxford Handbook of Operative Surgery is a decent start, and the internet is always there, so don’t be afraid to use it, but critically appraise what you find.

Step 3: Ask the right questions

Asking the right questions will get information from your trainer that no textbook could ever give you. In terms of earning yourself some cutting time, ask questions that signify intent and demonstrate knowledge and awareness.

If you don’t ask, you don’t get. Stay polite yet assertive, and always respect the response even if it is not the one you want. Patients’ safety should be at the forefront of your mind. Think before you speak, and don’t stumble over your words, because it may be hard for your trainer to avoid believing that your hands won’t follow suit. Say things like, “I’ve done this once before, perhaps I could start off and you can see how I go from there?” Avoid questions like, “This looks easy, can I do it?” and “What time is lunch?”

Also ask the questions that will not only give you valuable nuggets of information from your trainer but, if asked skilfully, will let your trainer know that you are ready to progress to scalpel wielding. Don’t show ignorance—if you think you could easily find the answer in a textbook, then hold fire. A good example would be, “Are there any situations where you would start the peritoneal incision laterally along Toldt’s line instead of the usual medial incision?” Now you are talking the right language. Take care not to seem to disagree with your trainer, as it may be seen as arrogance.

Step 4: Be realistic

The old adage of “see one, do one, teach one” is outdated and, fortunately, few trainers will subscribe to this. You will need to demonstrate competence in each step of an operation before going skin to skin. With this in mind a question such as, “Can I do the next laparoscopic cholecystectomy?” having only previously observed is clearly inappropriate. Take it one step at a time, and demonstrate an awareness of your own limitations and an appreciation that behind your trainer’s every movement and action lie years of experience and a deep layer of almost unconscious competence.

Conclusion: make your own training

As a trainee you must seek out opportunities for learning. If there are none, then create them—your ability to use initiative may turn out to be the very quality that sets you apart from your peers in this increasingly competitive environment. Your logbook will reflect this and will give evidence of how you have progressed.

If you become used to applying these four steps to all facets of training—anticipating and being available, reading around, asking the right questions, and being realistic (knowing your limitations)—you might just have the right attitude for a successful career in surgery.

Originally submitted for publication to BMJ Careers and reproduced with permission. Original article can be found here.

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