Critical Observation: Part 6

Critical Observation

Critical observation is problem the biggest part of your job that is very difficult to teach. When I precept and my student is pretty confident in their skills, I’ll sit and think out loud. The issue with OR precepting, is that we are always thinking about the entire room, and it gets exhausting talking through all of it. And we don’t know where the student is, in terms of how much information is too much.

When my student asks more questions or looks at their phone, it indicates to me that they’re ready for scaffolding to the next phase. So challenge them. What do you notice? What can we do to make the next step easier? What do we need for the second case? Is there anything we need for the second patient? Streamline the process, be grateful for the time to reflect on what you’ve done – could you have done anything differently or better?

How is the room looking right now? How much blood is in the bucket? Are the surgeons joking? Is anesthesia concerned, looking at their monitors, walking over to look at the bucket?

Is there tension? How can you help? Are the lights stuck in a position where the surgeons are upset? Is the music too loud? Do you know that the faculty doesn’t like the music the resident put on? Are the pagers going off? Are there too many people talking in the room? How can you help?

The last piece is about medical students. Really anyone, but a majority of the time, it is a medical student who isn’t used to the OR, who didn’t eat, or is overwhelmed or tired, and you can see this blank stare at the wall.

Take all items away. Tell them to scrub out if they’re gowned in. Get them to a chair and get them to cold air, water, and a snack as soon as possible.

Someone on the surgical teams needs to stay with the student, if they can’t scrub out then you need to stay with the student. Call your charge nurse and make her aware of the situation.

Try to catch the situation before it becomes a real situation. That’s the biggest part of observing and noticing little changes. You are the gate keeper between the room and chaos. Take it literally, but not personally.