07 October 2010

On scrubbing

I have recently spent several weeks on surgical services within ob/gyn. It's been much more interesting and fun than I expected, however there were a few surgeries where the fellow or the attending told me *not* to scrub in. I was still in the OR, observing the surgery, being asked questions and being taught, but somehow, it's not the same. When you're scrubbed in two things happen: you have a much higher chance of participating in some way and you feel like part of the team.

The first point - participating - is exciting. Throwing stitches, retracting, using electrocautery and various scopes are skills that are difficult to learn well without practice. Truthfully, it makes the surgery a little less boring as well and keeps your attention on what is going on and not on what the anesthetist is doing, what time the clock reads, or the conversations of the circulating nurses. More importantly, it is usually impossible to get a good view of what is being done below the incision if you're not part of the sterile field. This means your ability to learn anatomy and technique are compromised when you're not scrubbed.

The second point - feeling like part of the team - is important in encouraging the morale of the medical student, something surgical fields traditionally struggle with. In general, as a medical student I aim to be useful or, at minimum, not be a drag on my team. Getting told not to scrub is like being put on time-out. Either you've done something wrong or there is no possible way in which you can contribute - not even to hold the skin open. Talk about feeling small and unwanted.

It takes very little to make a medical student feel good and we spend most of our time feeling tired, understudied and unhelpful. It takes time to teach us and we're aware of that. Residents and attendings frequently go home later when they spend time including and teaching us and we're grateful when they do. But it takes no extra time to let us scrub and observe from within the sterile field, so c'mon, throw us a friggin bone here.

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