Theatre Etiquette: getting the most from your surgical rotation

The IncisionNo Comments

Issue 7 – Volume 4 – May 2017

by Tobias Richards

  1. Consider clothing and wear proper protective gear

Make sure to wear closed in shoes and always wear a hair cover/cap as a part of the theatre uniform; some scrub nurses may ask you to wear shoe covers which can be found in the change rooms. Beware - some scrub nurses are strict about this and might kick you out for not complying. Also, it is best to be safe and not wear watches, necklaces or rings as this can also cause issues if you want to get close to the operations (which of course you do). Don’t forget to wear a visor mask at all times when scrubbing into theatre to protect your eyes. Nothing is more frustrating than scrubbing into surgery only to have the wrong facemask or no visor and have to go through the whole process again and wasting the team’s time.

  1. Revise your aseptic technique

If you are unsure or nervous when scrubbing in do not hesitate to ask one of the scrub nurses to show you. I have never been rejected and at most they will ask you to wait until after the operation so they can have more time to take you through the whole shebang – very worthwhile having this technique taught multiple times to help it sink in. Proper surgical scrubbing technique is your gateway into surgery and so it is very good investment of your time to have this down pat. Be super careful around blue draped areas and surgical equipment. Leaning over sterile fields is also a no-go! Try and take direction from the scrub nurses and operating surgeons where to stand during the operation and feel free to ask the theatre nurse or surgeon where you can stand in order to best see the operation.

  1. Introduce yourself

Nothing is more awkward than looking from a distance during an operation and not learning or participating in the operation itself. How can you change this? Introduce yourself. As a bare minimum when watching any operation you must introduce yourself to both the head theatre nurse and the operating surgeon. I cannot recommend this enough, it highlights you as a respectful student, and you are much more likely to get teaching, hands on and assistance if you demonstrate yourself to be a polite well-meaning students from the get go. Something like, ‘Hello my name is X and I am an X year medical student, do you mind if I watch you operate today?’ In most operating theatres the theatre nurse will get you to write your name on a whiteboard so that they know who is present during the operation. Introducing yourself shows respect for the surgeon, and you are much more likely to receive teaching, especially if you include in your introduction that you have an interest in that area of surgery. Do not be shy with this, I would totally recommend this as your regular theatre etiquette.

  1. Be a part of the team

Once you have been allowed into the theatre – congrats, you are now a part of the theatre team. This new role includes helping the surgeons and nurses when transferring patients from the bed, as well as answering phones, finding equipment and anything else that the surgeon may prompt you to do. Your best bet will be to grab a pair of gloves and offer to help if the situation strikes, or keep an ear out if the surgeon directs you to assist her.

  1. Be assertive in taking opportunity

You won’t learn anything if you are standing two metres away from all the action. If there are two operating surgeons and room for a student (and you are comfortable with your scrubbing in technique) ask the consultant or operating registrar if you can scrub in and assist with the operation, ideally before the operation begins. Be confident and speak up, and the worst that will happen is they will say no. The surgeons generally love enthusiastic medical students, and by being shoulder to shoulder with the surgeons you are much more likely to remember the surgical procedure and anatomy as well as get hands on practice with suturing surgical knot tying, and also get a better feel if you could pursue a surgical career (especially after standing for three hour operations!). One further bit of advice may be to revise simple suturing techniques, i.e., the surgeons knot, and also a simple hand tie, i.e., one handed surgical tie. This way, if you do get a chance to suture a patient, you can be confident and do a good job. Don’t be a theatre hog and remember to consider other students on your team. At the very least offer to one of the other students on your team to scrub in if you already have and if rejected, it is all yours.

  1. Arrive before the operation and speak to the patient

Ideally it would be best to speak to the patient before the operation and get their consent for you to watch the operation, get a history and better understanding of the reason they are undergoing the procedure. This helps you to make the surgery more memorable, make sure that it is an operation you want to watch for the next four hours and also will increase your chances of scrubbing in with the consultant or getting a tutorial. If you mention to the surgeon that you have spoken to the patient, or are following the case, you are also much more likely to be allowed to scrub in and assist with the operation, as well as a follow up after for a post-operative assessment with the consultant after the patient wakes up.

  1. Find operations that you are interested in

The day’s operation lists are usually posted in the administration desk at the front of the theatre entrance or at the nurse’s station in the patient holding bay, e.g., at Fiona Stanley Hospital. if you are on a surgical rotation and want to know when an interesting operation is on during the day this is one way to go about it. There are also online booking systems for surgeries, but you will have to speak to your team to get the access to this, or chat to the scrub nurse and they may provide you with the log-on credentials for anytime access.

  1. Go slow when assisting in an operation

The surgeons will understand that you are a student, but it is important to move slowly and carefully when handling sharps or other pointed surgical equipment. Because you will not be able to see the surgeons face at all times, it is important to be sensitive to the prompts the surgeon will make with her hands and directions. Speak clearly, follow the instructions provided and you will be fine. Diathermy smoke is carcinogenic and so by grabbing the suction and slowly following the surgeons diathermy you will be doing a great favour as well as getting a feel for the operation itself. If you feel comfortable taking the initiative to do this during the operation will definitely score you brownie points for in-theatre teaching.

  1. Eat a decent breakfast

Surgeries often run overtime, and you may even get trapped in theatres with an overexcited consultant. So eat a decent breakfast – would totally recommend high protein foods.

  1. Thank the theatre team for allowing you in their theatre room and for helping in your professional development as a future surgeon

Consultants and registrars, for the most part, love to teach medical students and are enthusiastic about their area of medicine, even at the expense of their own working time and efficiency. Be sure to thank the surgeons and nurses for allowing you in their theatre as this will also pave the way for future medical students to complete their training on that rotation. UWA has a very good reputation in the theatres for politeness and you can help to maintain this high standard.


Tobias Richards is a fourth year medical student at UWA.

About the author:

Leave a Reply

Top