Theatre Etiquette.

As promised I will discuss about surgical theatre etiquette. Theatre is a really good way to see anatomy and learn more about the management of certain conditions.  Again like the wards it's a really daunting place to be in. I actually found theatre a bit of a scary place as there's so much equipment in there, but once you have experienced it...it really isn't that bad. Your consultant finally invites you to go to theatre with him next day so here are some tips: Find the theatre list for the day you'll be going into theatre so you can get an idea what you'll be seeing - best place to go is the consultant's secretary. This will allow you to do a bit of reading up on relevant anatomy for the surgery. Also a great chance to read up on the condition that the surgery is treating. Most consultants like to ask questions during surgery so make sure you're ready. Nothing worse than being the student that seems like he/she didn't do any preparation whatsoever. Also theatre starts at different times so it is something you'll have to find out from the consultant/registrar/theatre staff/secretary. Make sure you turn up for the very beginning as this is when everyone introduces each other and go through a team briefing. So you get to the hospital - what do you do next?

Head on to theatre and sign in. Go get changed into scrubs and put on a theatre cap. Make sure you also change into theatre shoes which are usually clogs/the super fashionable crocs. Hopefully your hospital have some theatre shoes for you to borrow so make sure you ask at reception first. Take off all jewelery. At all times make sure your ID is visible. In general for theatre changing rooms it is best to bring your valuables with you or simply don't bring valuables to a theatre day. I always bring my money and my phone with me and depending on the hospital I also bring my bag with me to theatre as it's just a small messenger bag. Make sure you leave the bag in the prep room or ask theatre staff where you can put your bag.

So you get to the theatre and hopefully you'll know who is the consultant. Go introduce yourself or say "Hi". You'll be surprised how often they don't notice you even though you think they saw you. I guess sometimes they can't recognize you as you are in scrubs and have a theatre cap on. Get in on the team briefing and pay attention to the theatre list for the day. Also find out who is the anaesthetist. Ask the anaesthetist if you can observe the patient being put to sleep. It's quite interesting to watch.

Simple rules of theatre:

• Don't touch anything green/blue in the operating room especially on tables/trolleys
• If you're going to faint - don't faint on the patient - so go sit down - it happens to everyone
• When the surgeons are gowned up - don't make any contact with them as they are now sterile so that means good dodging skills and just stay out of their way until they have gotten to their place at the table

Usually there will be 3 people scrubbed in and working on the patient. It will usually be 1 consultant surgeon, 1 registrar, and 1 scrub nurse. It'll be fairly obvious who is who. Scrub nurse is the one who will be passing all the equipment to the surgeons. If it is open surgery (not laparoscopic) you'll probably need to get a pedestal to see over the shoulders of the surgeons but make sure you ask them first/let them know you're standing behind them so they don't bump into you...but obviously don't be right up behind them - give them some space to breathe and move around. If you wear a lanyard for your ID badge - then this would be a good time to tuck it into your shirt so it doesn't swing around.

If it is a laparoscopic surgery - there will be a tv screen for you to watch so you don't need to be standing as close to the surgeons. Just find a good spot to stand and for me, I never sit down as I think the theatre staff are more deserving of a chair than I am. 

The problem with surgeries is that it can range from 30 minutes to 8 hours. You'll find that your back and feet will be hating you during long surgeries. Also make sure when you're standing for a long time just to keep your legs moving so you don't faint. Sometimes with long procedures I will go take a walk around the operating room just to get my legs moving again and give my back a stretch. No matter how much you love surgery (and take it from me - I really do LOVE surgery) - it will get boring especially when you're not scrubbed in and just observing. If nothing interesting is happening go talk to the anaesthetist. Ask he/she about the machines and what they are doing. The thing with surgeries as well is finding the right time to ask questions. There will be times where the room goes dead quiet as the surgeons are concentrating - obviously horrible time to ask a question. You'll be able to tell when they don't need to focus as much as usually they'll start talking about really random things like plans for the weekend...you'll be surprised what sort of things surgeons talk about during surgery. Some surgeons even have music playing in the background so don't be shocked when you walk in and there is music playing. I think the best one was when I was waiting outside a day surgery theatre and the doors to the operating room opened and all you can hear was music blasting out...almost seemed like a night club in there!

Hopefully your consultant will be good at teaching and he'll show you the relevant anatomy IF it is easy to see. Not all the time the anatomy is easy to see, but don't be disappointed if you don't really see much. Most surgeries that I have observed - I usually don't see very much so don't think this is your fault. Especially now, surgeons are trying to make incisions smaller to reduce the recovery time...but again as long as your consultant knows he/she has a student around - most are quite good at moving over and letting you do a quick lean in to take a closer look - again make sure you don't touch the patient/surgeons.

When the surgery is done - go make yourself useful and help the theatre staff with moving the patient. Put on a pair of non-sterile gloves and grab hold of one side of the bed sheets (other than the head as the anaesthetist will be there). It'll be made clear which way the patient will be going and usually the clue is probably the empty bed right next to the operating bed with a slide board underneath. The anaesthetist will always count you down to moving so some will say "On 3" or "Ready Steady *Move/Shift*" - either way it'll be obvious.

If the previous surgery was long - you might want to stick yourself onto the consultant/registrar as they usually will disappear to the coffee room. Go make yourself a drink or get some water - staying hydrated is key for surgery. Sometimes it is quite frustrating as you could wait for an hour before the next surgery. I always hate coffee room breaks - not because I hate waiting around...it's because sometimes the consultant needs to quickly pop up to the ward and you're left alone in the coffee room. Just keep your eye on someone who is from your theatre as they tend to leave without telling you. Well based on personal experience - I always get left behind so I always got to stay near the registrar/consultant/theatre staff just so I wont miss the next surgery. Another way is before breaking off to the coffee room - ask a theatre staff how long a break do you have or what time does the next surgery start - then at least if you lose everyone - you'll still know what time to get back.

Hopefully this gives you a better idea what to expect when going to theatre for the first time. Hey maybe you'll be lucky and get to scrub in. But don't be disheartened if you don't scrub in as I didn't get to scrub in til this year (3rd year of medical school - been on surgical placements ever since 1st year). So just enjoy your time in theatre and hopefully you'll see lots of cool things. Also a great place to witness some good teamwork and communication skills as well. If you're unsure about anything just ask a theatre staff.

How to Make the Most of Shadowing.

Right so I'm in the mood for a tips post so today I will be discussing how to make the most of a shadowing opportunity. This is mainly aimed to those who aren't in medical school yet.

Let's point out the obvious issues of shadowing doctors when you aren't in medical school yet:

• You can't do any clinical skills
• Don't have much knowledge in medicine 
• Daunting environment - very unfamiliar/disorientating 
• Never really spoken to a patient before

Common problems that you share with medical students:

• You get ignored
• Can't do very much (depends on the placement/consultant)

So with the common problem of getting ignored...there isn't much you can do about it other than finding someone who won't mind having students around/is a good teacher. Not being able to do much is a universal problem. Fair enough some patients don't want to be handled by a student and there has been several times where I have found myself sitting in a corner like an old piece of furniture. It's just something we all have to accept.

Right so as a prospective medical student you want to get some experience and see what it is really like to be a doctor so you ask to shadow a doctor/consultant. So how do you make the most of it? Because you won't have much knowledge about the specialty, the best thing you can do is observe the key skills that a doctor needs. The main skills you'll notice are:

• Communication skills
• Empathy
• Teamwork

Communication is probably the most important skill to have as a doctor. The profession involves a lot of talking to patients, but also the need to listen to the patients as well. Watch how the doctor talks to a patient. Listen to how he/she asks a question. Usually doctors start a consultation with open ended questions to allow a patient to elaborate why they are in clinic. Watch the rapport that the doctor establishes with the patient. The best way to get info from a patient is to get them to trust you so the first few seconds of a consultation is key. Don't dig your head too deep into the medicine. Just focus on the interaction between the doctor and the patient. Some of the consultants who I have been attached to describe it as an art form. Communication is literally needed everywhere. Communication is key in theatre, clinics, and on the wards. If you're fortunate enough to go onto the wards, take some time and talk to the patients. I took my first patient history 1 month into medical school and hardly knew any medicine at that time. Take a social history which involves asking the patient about how his/her medical condition has affected them. Try to find a patient with a chronic disease such as heart conditions. Find out how their condition has changed their lifestyle. This is a good way to practice your communication skills and creating good rapport with the patient. Plus most patients on the wards are really bored so most will welcome a nice lil chat.

Empathy...I've made a post about this not too long ago. Again another important skill and something you'll sometimes see. Talking and listening to a patient is one thing, but watch to see if the consultant shows a bit of empathy. Sometimes patients have a tough time with their medical condition and SOME consultants do take the time to empathize.

Being a doctor involves a lot of teamwork. It is certainly not a one-man job. In clinic, you'll probably have a nurse helping out. Just watch how the doctor and the nurse interact and how they have to be on the same page. Essentially the nurse keeps the clinic running smoothly and on time. You'll probably see more teamwork in the operating theatre. There is always about 6-8 people in an operating theatre so again stressing the importance of communication skills and teamwork skills. Sometimes the consultant may invite you to a MDT meeting (multidisciplinary team meeting). There will be microbiologists, radiologists, surgeons, physicians, nurses, etc all sitting in one meeting to discuss complex cases. Not only do you have to get along with people in your own specialty, but you'll have to get along with people in other specialties. So essentially the care of a patient isn't just in one person's hands...but in many many other people's hands. If you can, take the time to appreciate this as when I first started out in medicine I didn't expect THAT many people to be involved in a patient's care. It was actually surprising and quite amazing how people manage to stay organized and not mix things up (but it does happen from time to time).

Oh and if you really don't know what's going on...best thing to do is just smile and look interested. No one wants a grumpy/tired/not interested student around them. If a doctor sees that you're interested then he/she will be more willing to teach. I've tested this so this is based on first hand experience. Recently in my last orthopaedic attachment...I was falling asleep in clinic (due to jet lag) and my consultant hardly said anything to me or really taught me anything. He just left me alone. Next clinic...got over my jet lag...more keen...leaning forward and looking interested - learned loads. My consultant taught me so much and he seemed to enjoy my company as I was interacting with the patients and with him as well.

Another tip is that if you find yourself on the wards and no one to follow - go find the junior doctors. They know what it is like to be a student as it is still fresh in their minds and they'll probably be able to sympathize and show you some interesting things suited for your level. I've encountered prospective medical students in the hospital before and don't be shy and just ask for help. For me, I'll always be happy to help unless I'm busy. Same goes with junior doctors/doctors of any level. As long as they aren't doing something really important/look really busy, just introduce yourself and ask em if they can show you around/teach. Just make sure they know you're not a medical student and just want to get a taste of what it is like to be a doctor. Some might even get a break and sit down with you and tell you what their day is usually like.

Good luck and I hope this post helped!

Doh!

Interesting and short week of paediatrics. Had Monday off as I was in for 9-5 lectures. Tuesday..can't remember what happened...obviously nothing exciting as I would remember. I was on-call again on Wednesday so I was in the hospital from 8:45am - 9pm. It was also my SHO's last day and to be honest I think he was really great. Probably the few doctors that really made us medical students feel very welcomed and a part of the team. He's also really good at teaching too. Really smart dude. As a medical student, the biggest worry is being left out from the team. It's already nerve-racking to step into an unfamiliar environment and have no clue what you're supposed to do, so when a doctor welcomes you and teaches - you feel much more at ease and it really makes a huge difference to your experience at the hospital.  It was also nice that he could remember our names and it really helps with making us feel welcomed. Great thing about this SHO is that I understood him. I knew when to bother him and when not to. And it seems like he too knew what I was like. Seriously, some of you may think I'm really hard working, but I am definitely not the hardest working student to have graced medical school. In fact, I'm quite lazy (blushes). It was interesting how my SHO could tell that there are times where I don't want to do anything and he lets me be. It was like we were on the same page so it was good we had this mutual understanding.

Took quite a few "tea breaks" during my on-call so I got to talk about life as a doctor with the SHO as the ward wasn't too busy either. It was eye-opening. But the conversation soon led to a massive "DOH!" moment. Out of no where I was asked: "You don't like Paediatrics very much do you..or this attachment in general right?" I was actually left speechless. My face was probably a mix of a dead pan with a "DOH" moment. Secretly inside...I haven't really been enjoying this placement very much as in general I'm not very interested in Medicine. I really miss going to theatres and watching surgeries as I find it much more interesting and exciting. I have tried my best to put on an enthusiastic/keen face during this placement, BUT apparently it is fairly obvious I don't really like paediatrics. Another interesting bit is that the SHO could tell what I wanted to do in the future. Haven't told him what I was interested in and he randomly was like: "You're definitely going to do surgery. It's written all over you." And for some of the followers of this blog, you probably know I want to do Orthopaedic Surgery in the future so it was nice that people can see I want to do surgery. On top of that, the day after, another doctor went up to me and was like "You don't like Paeds very much do you. It's like written all over your face." Cue another "Doh!" moment. I even asked if it was that obvious and everyone around me was like "Yes." Soooo....it probably means my supervisor/consultant can also tell I'm not really enjoying the attachment. Honestly though, I'm not HATING it, but I don't love it either. I'm quite indifferent about it and I do realize I'm quite awkward around kids as I don't know what to do with them. Guess it's something I have to work on...and I am trying quite hard though...guess that's what matters.

Next week there will be new SHOs starting on the job and meaning starting back at square one with trying to get on with the new doctors. Life is always full of changes and you just have to keep adapting. Also being a medical student you constantly have to remind yourself that you're at the bottom of the ladder and you really have to work hard to get noticed. Note to self: Stop making it so obvious that I don't like kids.

FRESHERS WEEK - MEDICS FIELD HOCKEY

Well today was also the first day of training for the medics field hockey team! I met at the hockey pitch at 5:00pm which my massive goalkeeping bag. It was quite the hike up to the pitch as it was on the top of a hill and there were several flights of stairs I had to carry my bag up. There was lots of people at the practice, but sadly I only met a few freshers there. I have already met the club captain a month before I started uni to discuss about playing 1stXI team. Met a few people who are on the team when I got to practice so that was really cool. So all the people on the team are medics and most of em are upper years so I asked em a few questions about their thoughts on med school.

The general response that I got from them is that they thoroughly enjoy medical school and that I should try and have as much fun as I can in first year. All of them really loved first year of medical school as it wasn't too hard. The medical school tries really hard to make transition from school to university as easy as possible so a lot of the students really liked the transition and thought it was at a good pace.

Practice was a lot of fun...I haven't really trained with men as well so it was definitely a new experience. I was definitely expecting really hard shots...but wow can men shoot the ball! I thought I was going to get killed tonight. My goalkeeping shorts are not up to standard to start off as they are only suitable for low grade hockey...what a great confidence booster. I didn't really get hit anywhere with little protection which was good. Personally thought I played OKAY...but I was pretty tired.

After practice we went for a big team dinner at the local pub. Had great pub food and played some games such as "Boat Race". It was a lot of fun. We also went around the circle and introduced ourselves to each other. Can't even remember 1/8 of the names (terrible with names). Once dinner was finished I had a good chat with the older medics and asked them about intercalated degrees and what they thought about it. They actually thought that taking an extra degree will help you final application for foundation year placements and it shows interest in whatever specialty you are looking at. However, they did tell me that it is a bit too early to start thinking about it as usually people take an intercalated year. I am keeping the intercalated degree idea at the back of my head for now as I am considering it.

Hockey was really fun tonight and I managed to meet lots of people. Yay!

Tip: Don't be afraid to talk to upper years in your course. They may come in handy when you need help with course work or just have a question about the course. Don't worry they don't bite...although some of them may do look like they bite. :P