kittryn Posted May 12, 2014 Share Posted May 12, 2014 hi all - I am starting a locums position in mid-june which is inpatient surgery which has in the description, "OR experience not required but it would be nice". I have OR experience from 6-7 years ago which was inconsistent bc I worked off-shift (nights/weekends). I always tell the truth about this when I go into an OR, meaning, "I need some guidance", but I get wicked performance anxiety, like I'm supposed to know how to do everything. this can sometimes actually lead to a vaso-vagal thing and I've had to break scrub a few times from this (ouch!). they have a new batch of residents coming in and I could just hand over the residents to the OR and cover the floor...but I really want to get more comfortable in the OR and polish my skills. suggestions? job starts ~1 month from now. it's my mind that works against me - tells me I have to be perfect and all-knowing and I know I'm not. Link to comment Share on other sites More sharing options...
cinntsp Posted May 12, 2014 Share Posted May 12, 2014 SSRI? Sent from my Nexus 5 using Tapatalk Link to comment Share on other sites More sharing options...
kittryn Posted May 12, 2014 Author Share Posted May 12, 2014 SSRI? Sent from my Nexus 5 using Tapatalk I'm already on those. isn't it beta-blockers that are supposed to help with performance anxiety (ie "flop sweat")? Link to comment Share on other sites More sharing options...
andersenpa Posted May 12, 2014 Share Posted May 12, 2014 is this general or specialty surgery? eat something light before you scrub in (snack bar, banana etc) if you are new the surgeon and OR staff shouldn't expect you to know everything. the "basic three" as an assist are knots, suction and retraction- so always have one hand free and one hand with suction or a pickup. the final (and probably most important skill) is anticipation. alot of this depends on knowing the operation, but it can also be pretty basic (if the surgeon is tying, be ready to cut; if working on specific tissue, be ready to mobilize/retract) the staff should be accomodating to your competency level so don't overthink it and have fun! Link to comment Share on other sites More sharing options...
kittryn Posted May 12, 2014 Author Share Posted May 12, 2014 is this general or specialty surgery? eat something light before you scrub in (snack bar, banana etc) if you are new the surgeon and OR staff shouldn't expect you to know everything. the "basic three" as an assist are knots, suction and retraction- so always have one hand free and one hand with suction or a pickup. the final (and probably most important skill) is anticipation. alot of this depends on knowing the operation, but it can also be pretty basic (if the surgeon is tying, be ready to cut; if working on specific tissue, be ready to mobilize/retract) the staff should be accomodating to your competency level so don't overthink it and have fun! general. includes vasc/thoracic/bariatric. I have experience with gen/thoracic/bariatric; minimal vasc. I like the "don't overthink it" part - that is sooo me!! Link to comment Share on other sites More sharing options...
quarternote Posted May 12, 2014 Share Posted May 12, 2014 This book is excellent for surgical review before unfamiliar cases: http://www.amazon.com/gp/aw/d/B00HYHB63M/ref=mp_s_a_1_4?qid=1399923901&sr=8-4π=AC_SX110_SY165_QL70 Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
cinntsp Posted May 12, 2014 Share Posted May 12, 2014 I'm already on those. isn't it beta-blockers that are supposed to help with performance anxiety (ie "flop sweat")? They help with the sx but you probably don't want to pop a beta blocker before every case, haha. You might consider some CBT if you're looking to get to the root of the problem. Sent from my Nexus 5 using Tapatalk Link to comment Share on other sites More sharing options...
kittryn Posted May 12, 2014 Author Share Posted May 12, 2014 This book is excellent for surgical review before unfamiliar cases: http://www.amazon.com/gp/aw/d/B00HYHB63M/ref=mp_s_a_1_4?qid=1399923901&sr=8-4π=AC_SX110_SY165_QL70 Sent from my iPhone using Tapatalk just ordered it Link to comment Share on other sites More sharing options...
kittryn Posted May 12, 2014 Author Share Posted May 12, 2014 They help with the sx but you probably don't want to pop a beta blocker before every case, haha. You might consider some CBT if you're looking to get to the root of the problem. Sent from my Nexus 5 using Tapatalk once I get through the first incision I'm good, so I don't think I'd have to take them for every case :) I just got psyched-out once I vaso-vagaled, bc my fear that it would happen again made it worse each time. talking to my therapist about it is a good idea. and I'll ask my dr about the bbs Link to comment Share on other sites More sharing options...
winterallsummer Posted May 12, 2014 Share Posted May 12, 2014 My advice - learn which surgeons are good to work with and scrub with them as often as possible. Hand off the difficult surgeons to the residents until your anxiety is under control. A few basic tips 1. Get on YouTube and look up surgeons tie and learn the simple two handed technique with thread and a coffee mug (tie around the handle). 2 when the surgeon is tying a knot ask for scissors. Cut close to where he tied unless he says leave a tail 3. If doing nothing then have suction ready when appropriate. Suction close to bovie but not cut off his view As you become more comfortable you will be doing more advanced techniqes I'd assume. Link to comment Share on other sites More sharing options...
kittryn Posted May 12, 2014 Author Share Posted May 12, 2014 most procedures are min invasive or, (for thoracic), VATS, so suction isn't really at play - guiding camera or grasping, bovie-ing if the surgeon wants to be the one handling the tissue as I bovie...those are more common scenarios. Link to comment Share on other sites More sharing options...
quarternote Posted May 12, 2014 Share Posted May 12, 2014 I worked in General/Bariatric Surgery the first 5 yrs. then spent a yr as a hospitalist. Didn't you spend some years in General Surgery? Many of our cases were laparoscopic so my hand tying, etc was not what it should have been. Also, after a yr off I was very rusty on my suturing. Practice, Practice, Practice. Especially things like knots to tie off vessels or closing fascia. I've now transferred to Neurosurgery. I always said I would never work in this field as this was my weakest area in school. So that being said, I had an adjustment to make and from my viewpoint am still adjusting. All of the above suggestions are good. Forgive me if I repeat some. You Tube is great. Also depending on the specialty Web Surg. These are some things that have helped me: The book I posted above is a book the Surgical techs I worked with that have been doing this 20 yrs used to look up cases that they had not done in a while. It is a lifesaver. Every surgeon is different but it will give you an idea. Make friends with the Techs and the Circulating nurse and then get a copy of the list of surgical preferences for each procedure. In our OR they print one for each case so I collected them and saved them. In the General Surgery job they sent me an electronic copy which is easier to keep up with. After 6 months I've found that my boss is happy if I get there early, Round before we start, do the discharges, etc. and Have any images (MRI/CT) open & on the monitors) before she or the patient is in the room. It's not as bad as it sounds. I just get there about 30 min before she does. I am more than willing to help you with anything that comes up if you want to PM me. We do have long cases so during the day it sometimes takes a while for me to answer. Kim Link to comment Share on other sites More sharing options...
kittryn Posted May 13, 2014 Author Share Posted May 13, 2014 I worked in General/Bariatric Surgery the first 5 yrs. then spent a yr as a hospitalist. Didn't you spend some years in General Surgery? Many of our cases were laparoscopic so my hand tying, etc was not what it should have been. Also, after a yr off I was very rusty on my suturing. Practice, Practice, Practice. Especially things like knots to tie off vessels or closing fascia. I've now transferred to Neurosurgery. I always said I would never work in this field as this was my weakest area in school. So that being said, I had an adjustment to make and from my viewpoint am still adjusting. All of the above suggestions are good. Forgive me if I repeat some. You Tube is great. Also depending on the specialty Web Surg. These are some things that have helped me: The book I posted above is a book the Surgical techs I worked with that have been doing this 20 yrs used to look up cases that they had not done in a while. It is a lifesaver. Every surgeon is different but it will give you an idea. Make friends with the Techs and the Circulating nurse and then get a copy of the list of surgical preferences for each procedure. In our OR they print one for each case so I collected them and saved them. In the General Surgery job they sent me an electronic copy which is easier to keep up with. After 6 months I've found that my boss is happy if I get there early, Round before we start, do the discharges, etc. and Have any images (MRI/CT) open & on the monitors) before she or the patient is in the room. It's not as bad as it sounds. I just get there about 30 min before she does. I am more than willing to help you with anything that comes up if you want to PM me. We do have long cases so during the day it sometimes takes a while for me to answer. Kim thanks, kim. yes I did work in gen surg, but as I wrote in my OP, it was 6-7 years ago, and my presence in the OR was inconsistent bc I worked off-shift (nights/wknds). it usually meant emergent lap appys, lap choles, strangulated hernias, obstructed bowel, etc. so no day-after-day, regular, scheduled days in the OR where you do numerous cases on OR days. just the bust and hustle in the middle of the night. so...not exactly an experience which built my confidence for OR skills. but I am grateful for the suggestions and the support. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 13, 2014 Moderator Share Posted May 13, 2014 realize you are doing locums -and don't care so much only places that hire locums are desperate and might be a HORRIBLE place to work, or just growing to fast.... BUT you are locums so you really don't care...... from my military days Eat, drink, don't lock your knees when standing, tighten the core muscles and all your leg muscles to avoid passing out, but if yu are going to pass out for gods sake sit down first - passing out never good.... Be honest with the surgeon "its be a few years since I have scrubbed in so just tell me what you want me to do....." Enjoy the experience - you are locums! Link to comment Share on other sites More sharing options...
kittryn Posted May 13, 2014 Author Share Posted May 13, 2014 realize you are doing locums -and don't care so much only places that hire locums are desperate and might be a HORRIBLE place to work, or just growing to fast.... BUT you are locums so you really don't care...... from my military days Eat, drink, don't lock your knees when standing, tighten the core muscles and all your leg muscles to avoid passing out, but if yu are going to pass out for gods sake sit down first - passing out never good.... Be honest with the surgeon "its be a few years since I have scrubbed in so just tell me what you want me to do....." Enjoy the experience - you are locums! awesome :) Link to comment Share on other sites More sharing options...
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