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Whether you’ve only seen it on TV or heard stories from upperclassmen, the operating room (OR) can be an intimidating place. As a medical student, you want to strike a balance between learning and not interrupting patient care. Make sure you are respectful to all of the staff, find small ways to help, and are aware of your surroundings at all times, but also listen to your body to take breaks!
What do you need to wear and bring?
Clothes: You’ll change into hospital scrubs before entering the OR, so what you wear doesn’t matter much (just remember you'll be walking through the hospital to get to the changing rooms).
Hospital scrubs are located on the second floor in Building 2 a little ways past the OR
Grab scrub pants and a shirt in your size (sizes are "unisex" so do your best to find something that fits). Grab a jacket if you get cold easily.
You'll need your ID to swipe into the locker rooms to change. Students do not get designated lockers, so pack light or leave your things in the *Surgical Skills room.
Before entering the OR area, grab a scrub cap/hair net and booties/shoe covers from the break room.
Students who practice hijab- we have heard rumors that they will start carrying hijab covers, but for now, grab a scrub jacket to cover your arms and wear an ortho hood if you can find one! Also, the scrub tops have some plunging necklines, so feel free to wear a turtleneck underneath for extra coverage (and warmth).
Once you enter the OR, swap out your mask to one found above the scrubbing stations.
Scrubs are comfortable and appropriate to wear before you change into the hospital scrubs.
You can purchase scrubs at wearfigs.com, codenextscrubs.com (Mayo student-founded), Amazon online, Scottsdale Scrubs, or Scrubs and Beyond (locally), and Walmart for the cheapest options.
If you plan to shadow in the clinic later in the day, bring professional clothes to change into. Generally, the rule of thumb is that if more than 50% of your schedule requires OR time, you can wear your scrubs that day. If it's less than 50%, you'll have to change, but always double check with your attending to see what's most appropriate.
Shoes: Wear comfortable/tennis shoes and expect to stand for many hours
Insoles and long compression socks can really make a difference.
You can get cheap tennis or scrub shoes from Walmart or other shoe stores. The scrubs shops listed above sell more expensive but high-quality scrub shoes. Just beware that you may get blood on your shoes (higher likelihood if you choose not to grab shoe covers).
Other:
Bring eyewear (Amazon, school/hospital-provided, or glasses).
Stash a protein bar in your scrub pocket for a quick snack (go to the break room to eat it. There is absolutely no eating/drinking in the OR).
Bring a pocket notebook and pen for quick notes/thoughts/questions to ask later.
No jewelry, it might get lost. Small earrings, necklaces are fine. Absolutely nothing on your hands/arms if you plan to scrub in.
Don’t have painted/press on nails (surgeon opinions vary, but this is safer).
How do you get to the OR area?
Surgeries generally start after the stated time due to setting up, but you should still get there 5-15 minutes before the stated time on the first day.
Allocate time to change into hospital scrubs (building 2, second floor), put on a scrub cap, surgical mask, and shoe covers.
Figure out if you are in the general OR (building 1) or satellite OR “SOR” (building 3, left at the end of Hope Hallway).
Look for the OR Room on the computer/TV screens. The surgeon's name will be there and they typically use the same room the entire day.
In between surgeries when you have downtime you can head to the *Surgical Skills room (Specialty Building 2, 3rd floor) which has seating, computers, and simulations. Here you can do work or practice suturing, laparoscopy, the da Vinci robot, and more. You can also leave your things in this room since students do not have designated lockers in the changing rooms.
What are some general tips?
Each surgeon has their own style, sometimes you’ll just shadow and sometimes you’ll get to scrub in and act as “first assistant” (often the PA or resident's job).
Communicate with the surgeon about what you are hoping to get out of the experience, ex. “If there is an opportunity today, I would love to get hands-on experience”.
The PAs are incredibly helpful. They are often approachable and willing to teach.
Get to know the staff (RN, PA, scrub tech, etc.). They know the OR inside out.
hot tip: introduce yourself to the team when you walk in and write your name on the whiteboard.
Watch and learn the routine of the OR. Eventually copy easy tasks if you feel comfortable.
Learn to think ahead and “read minds” to keep operations smooth.
Don’t be afraid to take or ask for breaks. You’re just a student and the surgeon is probably focused on their task and may not remember to tell you to go on break.
You can use this time to read up quickly on the next procedure(s) so you can keep up and get the most out of the experience - not required, but helps with your learning
For example, if you know that you are going to shadow in gynecology, freshen up on your pelvic anatomy ahead of time or in between cases.
Check out this general guide to some of the tools you may see: Surgical Instruments
Suture Workshop PPT (courtesy of Dr. Patty Lu)
What to do before surgery?
Do a full scrub in with chlorhexidine before the physician gets there so you can do dry scrub (Avagard) on short notice - you should learn this as a first year, but if you don't feel totally comfortable, ask the scrub tech or PA to guide you. They have to scrub in to lay down supplies before the surgeon gets there anyways.
If there’s going to be radiation risk, make sure you have a fitted lead vest (they’re heavy).
Make sure the scrub tech has your gown and gloves before you scrub in.
Learn how to grab your own gloves and gown from the core and drop them onto the table (maintain sterility, or let scrub tech/nurse do it if you don’t know how).
Know your glove size (you’ll get it during surgical skills or through trial and error).
Write your name and year on the whiteboard, make sure it’s there between surgeries and not wiped off.
Introduce yourself to the nurses, they are super helpful and nice!
When do you scrub in?
First, make sure the surgeon has clarified if you can scrub in for a procedure or if you should just watch without scrubbing in.
If the physician is there, they take priority to scrub in.
Order of priority is usually: surgeon, resident, PA, MS4 (i.e. student on their sub-internship or elective rotation), MS3 (student on clinical rotation), MS2, MS1. If you are shadowing with another student, offer to alternate scrubbing in if there isn't a priority concern.
If the physician is not there yet, make sure the scrub tech is at a slow point and has time to get you in -- it’s good to get scrubbed in before the physician if you can.
What are some common sterility mistakes?
Pulling down the gown sleeve with an ungloved hand (although it’s helpful to the scrub tech for you to pull your sleeve down with your hand inside the cuff or a sterile glove on).
Someone moving their head or back onto your gown.
Touching things that are blue or plastic (ex. imaging equipment).
How can you help in surgery (i.e. while scrubbed in)?
Setting up:
Screw on sterile light handles, position lights
Get in close to the bed/table and put your hands on the patient (prevents you from accidentally touching something else)
While the surgeon is cauterizing: ***DO NOT put your hands in the field unless the surgeon has given you explicit permission. When you are allowed, you can:
Suction the smoke
Dab away blood with gauze
While the surgeon is suturing:
Dab away blood with gauze
Cutting: make sure you always have a pair of scissors when someone is suturing
Hold scissors with thumb and ring finger
Ask if you should leave a tail
If it’s cutting at the knot, tilt 45º and slide to the bottom
Cut with the tip of your scissors
If they’re doing a running stitch, “follow” them by giving tension to the slack
Once they're done suturing, wipe the wound with a wet Ray Tec sponge then dry with a dry Ray Tec.
If you’re suturing: adjust your light and don’t be afraid to ask for table height change
Retracting: holding tissue out of the way so surgeon can see the anatomy
Let the surgeon place the retractor then you hold it in that position
“Tow” by tilting the furthest end from you downwards; this prevents the end from pulling out
Remove it when the surgeon is done with that angle
Irrigation: rinsing out the wound
Hold the bin to collect fluid, keep track of where it’s dripping
Use the suction to collect the fluid while the bin is tilted
If there are multiple suctions (cardiac has heparinized, “pump suckers”, bypass, etc.), make sure to ask which suction to use
Generally:
Allow the surgeon to focus so be mindful of when you ask questions
Return unused tools to the scrub tech
Give tools directly into the surgeon’s/scrub tech's hand, they don’t want to lose their view
return sharp tools "backwards" (i.e. hand them the handle, sharp facing away from the person receiving the tool)
Keep track of gauze/items
Get comfortable squeezing into close quarters, the surgeon/PA/scrub tech is used to people in their personal space
What to do if you don’t scrub in?
You can get close behind the surgeon because backs are not sterile.
Get a step stool if you can’t see.
Ask the anesthesiologist if you can stand with them if there’s a good view from the head.
Help people tie up gowns in the back or velcro on lead vests.
What to do between surgeries?
Ask “How can I help turn over the room?”
Pick up trash, move carts outside.
Grab your gown and gloves.
Help move the patient between beds.
Help roll the patient/bed in/out of the room.
Ask the scrub tech/nurses how long you have if you need to take a break.
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