Being allowed to participate in an operation comes with the responsibility of learning everything about your patient’s medical history. In exchange for scrubbing into cases, you will be expected to know the story of how your patients presented and how their disease was diagnosed. Study your patient’s chart ahead of time and read the reports of all diagnostic procedures that have been performed, examine the blood work, and look up the pathology results of any biopsies. Make sure that you review the relevant imaging tests, not only by reading the written report, but also by looking at the actual pictures. Ask the resident who is assigned to the case to go over the films with you and point out the key findings. Once you have pieced together the patient’s story and know the planned operation, review the relevant pathophysiology and study the anatomy for the procedure being performed.

Be sure to arrive at least 15 min before your case is scheduled to begin. Note that as the day progresses, the start time listed on the OR schedule is merely an estimate; cases will start earlier or later than the stated time, depending on whether the prior case has finished. In order to be on time for your assigned case you will have to keep track of whether the room is running on schedule. Once in the preoperative holding area, introduce yourself to your patient and ask questions to fill in any gaps in your understanding of the history of illness.

Once your patient is brought into the operating room, it is a good idea to introduce yourself to both the circulating nurse and the scrub nurse. You should also introduce yourself to the attending surgeon if you have not met before. Help your resident with tasks like placing compression boots on your patient, inserting a urinary catheter, and shaving the operative site, as indicated. These may seem like small tasks, but they demonstrate your involvement and set the tone for rest of the case. Pay attention when the resident or attending performs a physical exam on your patient. Otherwise subtle findings often become evident once a patient is under anesthesia.

During the operation, stay focused and try to follow the sequence of events. In general, the more engaged you are, the more likely your team is to teach about the case. Most surgeons welcome thoughtful questions from a student during an operation, but make sure you do not ask any questions to which you should already know the answer. Be prepared to answer questions from your attending about the patient’s history, the relevant anatomy, or the disease process at hand. If you do not know the answer to a question, the best response is usually “I’m not sure, but I’ll look that up and get back to you.”