Guided journey
Your First Day in the OR
Eight stations, in the order the day actually happens. Take them one at a time, each is interactive, not a lecture.
1 · Before you enter
Dress the part
Scrubs from the changing room, theatre shoes, hat covering all hair, mask where the sterile field is open. Personal items stay in your locker.
Know the case
Read the history, the imaging, and the consent. Review the anatomy of the operation, it is the question you will most likely be asked.
Introduce yourself
Name and role to the scrub nurse and anesthetist, not just the surgeon. Ask where to stand and what you may touch.
Eat first
Standing still under warm lights on an empty stomach is how students faint. If you feel it coming: step back, sit down, tell someone.
2 · The surgical scrub
The Surgical Scrub
Arrange the steps in the order you would perform them.
- 1Remove jewellery, don mask and eye protection, open your gown pack
- 2Inspect hands and nails; clean under nails at the first scrub of the day
- 3Scrub fingertips to elbows systematically, keeping hands above elbows
- 4Rinse from fingertips down toward the elbows, water falling off the elbows
- 5Dry with a sterile towel, hand to elbow, a fresh surface for each arm
- 6Gown: arms into sleeves without hands emerging past the cuffs
- 7Glove using the closed technique, cuffs covered by the gloves
- 8Keep hands above waist and below shoulders, away from your face
3 · Entering the OR, spot the contamination
Scenario 1, Joining your first case
Flag every observation that breaks sterile technique.
4 · Meet the team
Meet the Team
Select a role. Sterile team members are marked in teal.
Attending surgeon Sterile
Leads the operation, owns every decision in the room, and carries overall responsibility for the patient.
For the student: Answer questions honestly, 'I don't know, but I'd look for…' lands far better than a guess.
5 · The surgical time-out
Surgical Time-Out
The room is quiet, the patient is asleep. Select everything that belongs in the pre-incision pause.
6 · Position the patient
Supine
Most abdominal and anterior surgery
Arms tucked or on boards; pressure points padded.
Prone
Spine, posterior structures
Airway and eyes are the anesthetist's chief concerns on the turn.
Lateral
Thoracic, renal, hip surgery
An axillary roll protects the dependent brachial plexus.
Lithotomy
Pelvic, perineal, urologic surgery
Legs raised together to protect hips; common peroneal nerve padded at the fibular head.
Trendelenburg
Pelvic and laparoscopic lower-abdomen
Head-down: shoulder supports and airway pressure changes matter.
Reverse Trendelenburg
Upper-abdominal laparoscopy
Head-up drops the viscera away from the diaphragm, and drops venous return.
Beach chair
Shoulder surgery
Cerebral perfusion is measured at head level, not at the cuff.
7 · The operation, and 8 · leaving the room
Incision, exposure, dissection, hemostasis, the operative objective, closure, then specimen handling, counts, dressings, handover, and the operation note. The best way to learn this rhythm is to live a case from consult to ward round:
Take your first case →