Claire McDaniel, MD | Liana Tedesco, MD
December 22, 2021
Time for the big show. What now? We have collaborated to bring you our best tips on how to prepare for a case so that you can shine when you scrub in. Junior residents – don’t worry if you don’t get to steps four and five until you are a more senior resident. Everyone understands, there is a lot of behind the scenes work that must be done. Follow these steps to get the most out of each operative case.
1Know Your Patient
This is the first step in preparation, plain and simple. No matter how routine the procedure, every patient is unique in their medical and surgical history. Know the medications that they take, how well controlled their blood pressure or sugars are, and how they have done after any previous surgeries. Knowing this can change how you operate and even what procedures to perform. Beyond knowing their medical and surgical history, it is important to go into the case knowing their preferences as well. This goes from ACL graft options to postoperative bracing, and how their life outside of the OR can impact your choices. Are they a professional athlete or a retired grandfather? What do they value? You are responsible for the person on the table, and they are putting their trust in you and the team to know their wishes.
2Know Your Anatomy
You cannot and should not operate if you do not know the anatomy. Knowing the pertinent anatomy for every case is critical–you can’t fix the fracture if you can’t safely get to it. Being comfortable with the anatomy also helps when dealing with complications in the case such as difficult reductions or revision surgeries. There are many ways to learn the anatomy, from classical textbooks to YouTube videos. Find a way that works well for you and stick with it, for every case.
3Use Your Resources
No one would say there is a lack of resources out there. From books to videos to virtual reality, we are lucky to have a variety of options. Firstly, it is important to know what medium works best for you. If you learn best by reading, grab a textbook. If you learn by watching, the AAOS Orthopedic Video Theater has over 1,000 peer reviewed videos you can turn to (https://www.aaos.org/education/orthopaedic-video-theater/). If you learn best by doing (and are lucky enough to have a residency program with access to VR), try running through the case with the programs. Find whichever resource works best for you. This may change as you progress throughout residency.
4Make a Plan
Imagine this is your patient and you are alone in the OR. How do you want to set up? What instruments do you want? What are the steps of the case? What complications may you encounter? Write it all down. Print it out and tape it on the wall in the OR. Take notes on it afterwards. If you are doing a total hip arthroplasty for the first time, make sure to use a templating software. If you are repairing a meniscus, make sure you know which technique you want to use. If you are fixing a complex fracture, make sure you have a plan for how you want to reduce the fracture and know which plate or nailing system you need to have in the room. Taking the time to make this plan before you show up to the operating room will quell any anxiety you may have about any given case and make your day run more smoothly. Just a few less decisions to be made on the day of surgery so you can concentrate on doing the surgery.
5Talk to Your Attending
This is likely your best, albeit underutilized resource. Your attendings are the experts! Discussing the case with your attending, particularly if you have a plan in mind, shows initiative and preparation. Even if your plan is different from your attending, this step will show you have considered the options. At this point, you can ask any burning questions about indication and technique. It is an excellent opportunity for some one-on-one learning (don’t forget to take notes!). In many cases, this step may be the gateway to a more hands-on experience in the operating room.
When the case is done, there is still a lot that can be learned! It can be useful to keep a log of your cases, not just for keeping track of case numbers, but also as a reference for future cases. This doesn’t have to be a physical book–although that works well! Write down the procedure performed and the patient so you can look their imaging up in the future. If it’s an uncommon procedure, consider writing down your whole surgical plan. If it’s a routine procedure you’re more comfortable with, put something down that you liked or that you would change for future cases. You can look back through this case log before future surgeries as part of your preparation.
At the end of the day, the more prepared you are for a case, the more you will learn from it. Even when you are slammed with other tasks, taking the time to think critically about a case will make the operating room experience more educational and enjoyable!
DISCLOSURES: Dr. McDaniel a close family member who works for Ferring Pharmaceuticals (makes Euflexxa). Dr. Tedesco This individual reported nothing to disclose.
Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.
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