Assisting in Surgery 101

‘What year are you in, again?’

That broke my concentration while trying to recollect the name of the B- forceps (Bloody babcock’s). ‘Fif-final year’ I said. He nodded his head and continued to watch me go through what felt like the Spanish Inquisition of instruments by the Registrar.

I was currently in theatre, dressed up in my new scrubs and wannabe Cristina Yang spirit, excited to finally some theatre experience! However, with each wrong answer, I was beginning to feel more like Nick Riviera.

‘Bam!’ Anaesthetist doors opened and the patient was rolled into operating theatre. The Registrar immediately left me to assist the staff with the patient. I stood on the side, next to the Consultant, unsure what to do. Shutting the leather cover, he turned to me, ‘So, do you know surgery is this patient going to have?’

‘Yes, inguinal hernia repair’, I replied confidently. Suddenly I was so thankful being early and attending the safety briefing- 3 inguinal hernia repairs.

‘Good. What type of inguinal hernia is it?’

‘Umm… indirect?’ Finger crossed behind my back.

‘Yes (Hope) ‘So what does that mean?’

‘Bowel herniates through the deep inguinal ring’

‘Good. Location of the deep inguinal ring?’

‘Mid-point of the inguinal ligament.’ (I am on a roll!)

‘Location of inguinal ligament?’

‘Pubic tubercle medially to the anterior superior iliac spine laterally’

‘Very good. (I mentally puff my chest)

‘Inguinal canal- what are the boundaries?’

Ba-dum-tsss!

Silence

‘Why don’t you read about inguinal canal and anatomy and get back to me’

Embarrassed, I sat on a chair in the corner of the theatre, trying to revive my lost memory of anatomy on 3G data. When I revised enough, I approached the Consultant who was getting ready to scrub in with the Registrar. He immediately instructed me to get scrubbed as well.

My inner Cristina Yang burst through, immediately scrubbing and gowning- the Consultant instructed I stand next to the registrar. The registrar picked up the scalpel and made the incision. He verbalized each step, as if guiding us. Eventually, I was asked to retract, which gave me a visual field as well. Throughout the procedure, the Consultant alternated between testing and showing the various structures along the way and even allowed me to hold the spermatic cord (nothing makes you feel more like a surgeon than holding an internal structure!). Once the hernia was repaired and mesh inserted, it was time for skin closure. The Registrar offered the opportunity for me to close skin- which I hadn’t done before. Instead, I observed while he taught me the principles of skin suturing.

The second case went along similarly, and I was a little more confident with identifying structures. By the third case, when the Registrar asked me if I wanted to attempt skin closure, I decided to take the opportunity and try my hand at it- it required a lot of instructions, a bit of handholding and a whole lot of encouragement from both seniors- and I was able to insert two sutures!

When I reflect on this day, as a practicing doctor, it sounds like an ordinary day. However, as a medical student, on that day, I finally understood the principles of the ‘Non-Technical Skills1’. By watching the debrief and intra-operative communication between Consultant and Registrar, I understood the importance of establishing an understanding, effective communication and supporting each other.

Another lesson I learnt was the importance of good learning environment as a result of exceptional teaching skills. While theoretical knowledge (aka anatomy) is the backbone of surgery, it is learning how to apply this knowledge practically that is imperative. Theatre excites medical students, offering an alternative learning environment for the practical application of the anatomy. Literature review identified that one of the barriers of students learning in theatre was the ‘lack of interest’ of the surgeon in teaching2. By involving me in the surgery and showing the practical translation of anatomy knowledge, I was more encouraged to pursue surgery.

Although a ‘typical’ theatre day, it certainly was a pivotal experience as a medical student leaving me with lifelong lessons as a surgeon.

References:

1. Croghan S, Phillips C, Howson W. The operating theatre as a classroom: a literature review of medical student learning in the theatre environment. International Journal of Medical Education. 2019;10:75-87.


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Noureen Fazili - SUTURE UK May Blog Competition Runner Up