First time in the OR, huh? Well, don’t touch anything. Just put your hands where I tell you to. You’re probably not going to understand anything we’re doing, so you can ask some questions when it’s a good time. As long as you read for the cases, you’ll be fine. Sit back and watch the master at work.

Don’t mind him. It’s easy to lose sight of how overwhelming this place can be. To make things more difficult, every OR is a little bit different. We’ll try to give you some tips that will apply to most of them and get you off on the right foot for the others. The first tip, as you’ve probably already guessed, is that the operating theatre (to use an old-school and Very British term) is a very structured place, with a long list of rules (both published and unpublished), and it can be tense at times. One of the key roles of the attending surgeon (which some fill better than others) is to make sure the right level of tension is maintained; too much tension makes the team ineffective, while too little could lead to distraction.

All right, so you think you are worthy of attempting to grace the hallowed halls of my operating room? Well, just know that I expect you to know EVERYTHING about the patient we are about to treat. I mean, shoe size, what they had for dinner two weeks ago, great-grandmother’s maiden name. EVERYTHING. However, don’t talk to me beforehand. Don’t make eye contact, as a matter of fact. Speak when spoken to, and softly at that.

Okay, so this is a little extreme, don’t you think? It is true: most of us expect you to know as much about the patient as is feasible and appropriate. It is important for you to know why we are taking this particular patient to the OR, why we felt that an operation is what this person needed. Next, read about the operation itself. How is it performed? A brief review of a surgical atlas will help you understand what we are doing, keep you engaged during the surgery by knowing the anatomy and the steps, and will impress the heck out your attending. Know about the disease process that necessitates operative intervention. Know about alternative treatments and possible complications of the procedure. That said, we understand how incredibly hectic and tiring it can be as a medical student on their first surgery rotation. Two or three years ago, you were an undergraduate trying to schedule all of your classes to start no earlier than noon, and now you’re waking up at 4 a.m. to be the first to round on patients, and then running from time commitment to time commitment. Maybe you were assigned to scrub the case 5 seconds before its scheduled start time. We remember what it was like. Just try your best. Be interested. Care about learning, care about the patient.

Here is a list of people who work in the perioperative area to whom you should feel comfortable introducing yourself: everyone. When it looks like we, the attendings, are free from distractions, introduce yourself to us. Introduce yourself to the patient and the patient’s family if no one from the surgery team has already done so. Explain your role to these people to increase their comfort level. Introduce yourself to the anesthesia team, the peri-operative nursing team, and the OR staff before the case starts. You will be surprised at how quickly you become included as a member of the team by introducing yourself, and by learning other team members’ names.

So, are you just going to stand there? How about a little shave? No, not for me, for the patient—you aren’t going to make a cut in that hairy mess are you? Forget it, the nurse can do that. Just get the lights and slam a catheter in. Page me when you’re prepped.

Now’s a good time to bring up that we have no idea what you know and what you don’t. You may have been an emergency department technician before medical school and placed hundreds of nasogastric tubes and urinary catheters. You may, on the other hand, be wondering which tube goes in which hole. Anywhere on that spectrum is just fine as long as you admit where you are. As you’ve hopefully already discovered, one of the best ways to approach any such task is to admit when you don’t know how to do something and ask to learn. “Learning by doing” is great. Learning by faking it and putting a patient at risk isn’t. We remember that performing invasive procedures on an awake patient can be mighty intimidating, so now is your chance to learn while the patient is asleep. Don’t be afraid to ask if you can learn how to place these tubes and catheters.

Even if you’re new to the OR, you can still help get everything prepared and move the preoperative time along. The nurses and technicians have a great deal of work to finish before the first incision, and with much of it you’re not allowed to help. However, anyone can help position the patient properly, move the overhead lights so that they’re pointing at the area where we’ll be operating, help place sequential compression devices, and, once taught, remove any unwanted hair from that area. If you haven’t already met the members of the OR team, now’s a good time; and if you can’t think of anything to do, one of the nicest ways for you to endear yourself to the OR staff is by asking them what you can do to help.