OR Etiquette When Resident Also Assisting

[Brotherman]

I started a new job in orthopedic surgery 4 months ago with an orthopedic surgical group. Some of the surgeons allow residents to train under them in the OR and clinic. So far, the residents have been cool and I’ve learned some stuff from them. However, I sometimes get the sense I am jockeying for position as the first assist. Ultimately, my role is to assist the primary surgeon. 

 

For instance, during shoulder scopes the resident will stand at the head of patient (lateral positioning), then the surgeon, and then I’m towards the feet of the patient. I noticed I’m pretty useless down there. Last week, I was respectfully assertive and stood at the head so I could actually assist. Total joints are a different story...I’m across from the surgeon and the resident is next to the surgeon by the head. 

My question is, what should my approach be? Should I appropriately establish myself as first assist? The resident and I will sometimes switch as to who is the main assist. I’ve also found myself be a little more in tune with opportunities to be steps ahead of the primary surgeon ready to be there to assist the next move...but I’m not in the main position and I watch the resident miss an opportunity. I would imagine that as I gain more experience and earn the trust of the surgeons, maybe my role will be more clear?

I want to do my job well but not be a d***. Any orthopedic PAs or surgical PAs work with residents in the OR? How do handle things?

 

 

[Arthropathy]

No experience with residents but my boss likes to teach and we have med students frequently. 

If we have an easy case I will simply ask  if I can wait to scrub until closing time. Gets me caught up on paperwork or seeing a post op real quick and can still help with closing and the student gets some quality time. Everybody wins. 

More complicated cases I might stand aside but jump in for more challenging portions and then back out again.  Sometimes the student has to be the one watching with hands folded.  And I always tell the student what inspect from them, and what my role is.

I would talk to your surgeon and ask what they expect from you when there are residents. Like you said at the end of the day your job in the OR is to assist the surgeon, and I'm sure they were are aware of how useless you are at times as a third set of hands, and might be more useful doing other tasks  (notes, scripts, seeing pre-ops, etc)

[SedRate]

On 12/27/2017 at 6:46 PM, Brotherman said:

I started a new job in orthopedic surgery 4 months ago with an orthopedic surgical group. Some of the surgeons allow residents to train under them in the OR and clinic. So far, the residents have been cool and I’ve learned some stuff from them. However, I sometimes get the sense I am jockeying for position as the first assist. Ultimately, my role is to assist the primary surgeon. 

 

For instance, during shoulder scopes the resident will stand at the head of patient (lateral positioning), then the surgeon, and then I’m towards the feet of the patient. I noticed I’m pretty useless down there. Last week, I was respectfully assertive and stood at the head so I could actually assist. Total joints are a different story...I’m across from the surgeon and the resident is next to the surgeon by the head. 

My question is, what should my approach be? Should I appropriately establish myself as first assist? The resident and I will sometimes switch as to who is the main assist. I’ve also found myself be a little more in tune with opportunities to be steps ahead of the primary surgeon ready to be there to assist the next move...but I’m not in the main position and I watch the resident miss an opportunity. I would imagine that as I gain more experience and earn the trust of the surgeons, maybe my role will be more clear?

I want to do my job well but not be a d***. Any orthopedic PAs or surgical PAs work with residents in the OR? How do handle things?

 

 

In the eyes of Medicare, the next most qualified medical personnel (e.g., ortho resident) is the billable first assistant. Further, your surgeon cannot bill for your services if there is a qualified resident available. Anecdotally, the few times we've worked with residents, the resident would be the first assist and I would be a useless third set of idle hands who would occasionally help out. I would sometimes just scrub out so that I could do more useful tasks and let the resident take care of closing. I wasn't expected to close when they were scrubbed in. If it was a simple case, I didn't even bother scrubbing in.

I agree with Orthohand and talk to your surgeon to make sure you are on the same page.