Training Perspectives Part I: Dummies guide to surviving an Orthopedic pre-operative case conference

in Orthopedics/Training by

It’s never a pleasant experience for me, as an attending, to see a resident tremble in front of the consultant staff, his pre- op case vanishing in room air and his morale at the level of the floor mat. I was in the same undesirable instances before, as any resident would be, not a long time ago. Often, the deja vu, nauseates my academic appetite. Ironically some of the best lessons I learned in my training came from such spectacular display of “enlightenment”.

I am in the opposite sitting arrangement now, as an attending, throwing the same bullish questions I lovingly evade before. But then again, if you are a resident and you accept your status as it is, this might be the best way of freeing yourself from such lowly self esteem!

A word of caution though. This is not Us, The attending vs You The Residents sort of set up. As Someonetc said, were all in these together. Nethier you or us nor the patients should lose. We all learn from it.

The common question from the frustrated resident is “How will I ever satisfy this ever critical attending? I’m always wrong to him!”So our residents will ask me, “how can I ever avoid such hell questions during pre-op?” In the short time I’ve been an attending (and the long time hibernation as a resident) these are the “attributes” I look for and emphasize during rounds and pre-op. In this particular order.

  1. Present the case for your patient. Know your patient, examine him well, take care of him, and decide according to his realities and situation. Put him in the top of your indication list. Err on his side. Overdo things for his welfare. I cannot emphasize more. Nothing irritates us more when the patient is not on your number one list or if you forgo the patient’s welfare just because you were busy with something else.It is always wrong to reason out that way!
  2. Never lie or bluff your way out. We will be sending you to vacationland for good or force you to jump-off training. Believe me.
  3. It’s the decision making process that I look in more. The logic behind why you do the labs, why did you decide to do the the surgery or not. This separates you from as a scientist and surgeon to a technician. Treatment protocols may vary, gold standard of treatment will change in the future, but logic and decision making attributes remain the same.
  4. Read for your case. Read voraciously what is relevant to your patient and case at hand. Hit your ortho books but new relevant studies will always grab our interest. Never come unprepared to the pre -op. No patient (not even you as a resident) would want a surgeon who doesn’t know what hes doing, to operate on him
  5. Accept mistakes and make good at your promise to do well next time. The attending will always remember the next time.
  6. Talk to your attending or consultant after the conference (and the patient) to make sure you got what they advised you.Its always a mark of a dignified resident to clarify his lessons and make sure he understands them well.

Again, we’re all in these together, you residents, us the consultant staff and the patients. I still believe no consultant is in there to personally destroy a residents career. Most of us are there to help you learn, learn the right way for you“-free of charge. Perhaps, thats the best assurance you can get from us.

Dr. Remo-tito Aguilar co-founded #HealthXPh. A board certified orthopedic surgeon, he is Chief of Clinics at General Santos Medical Center and Medical Specialist II Orthopedics at the Southern Philippines Medical Center in Davao City. Dr. Aguilar is a healthcare social media evangelist and writes his medical musings at The Cast & Curious (