June 2021

6/1/2021 | BY Sumeet Garg, MD, POSNA Resident Communications Committee

5 Tips for Preparing for Cases as a Resident

  1. Review the chart and imaging
    • Start with orthopaedic progress notes so you can understand the patient’s story and prior treatment. There will often be a discussion about treatment options including pros and cons of the planned surgery.
    • For medically complex patients it can be helpful to review notes from the primary care office, the problem list, and any relevant notes from specialists.
    • Make sure you have good quality pre-operative imaging. If you think there is something missing or inadequate quality speak up and let your attending know. Sometimes you may be the first one to catch that a pre-op CT or MRI was not completed, or a certain radiographic view is missing.
  2. Become familiar with the implants and surgical technique
    • Find out what implants are being used.
    • Search the internet or consult with implant reps to get the technique guide. Read it all the way through so you are familiar with how to use the implant and understand the different sizes available.
    • Often there are surgical videos that demonstrate the surgical technique and use of implants.  Search POSNAcademy (www.posnacademy.org), the implant vendor, Vumedi, and even YouTube!
    • If it’s the first time you are using an implant, consider asking the rep to get a set you can lay hands on and practice with.
  3. Write out a step by step surgical plan
    • Review the planned exposure and study textbooks and/or journal articles to be comfortable with the anatomic exposure. Know where tigers live, but also know portions of the exposure you can move quickly through.
    • Think about room setup and patient positioning.
    • For fractures, think about reduction techniques. Will you use indirect reduction or direct reduction? What tools will you want to have available? 
    • Template out your planned position of implants and confirm you have the right sized implants available for your case.
    • Don’t forget about the closure and post-op care – write out what sutures, dressings, and immobilization you’ll need after surgery.  Post-op rehab, weightbearing, return to sports, etc.
    • Think about common pitfalls in surgery and have backup plans for when they occur.
  4. Review your surgical plan with your attending
    • This is a great way to not only make sure you’re making progress with your pre-op planning, but also to build relationships with your attending staff. Most attendings will appreciate the time spent in preparation, even if your plan does not match their plan. You will learn from the way your attendings have planned cases.
    • Think about what specific goals you have for your development in the case. Until you are near the end of residency or a fellow it is unlikely you will be doing the case “skin to skin”. Discuss with your attending what skills you want to develop in the case and build from there as you progress in your rotation and residency. 
    • As you mature in your training, you may also find that some of your plans may become incorporated into the attendings surgical plan. As a resident, you are working with many attendings, often across varied hospitals. You may be able to bring new ideas and techniques to help improve care for your patient.
  5. Take care of yourself
    • Get a good night of sleep before operative days.
    • Eat well before surgery.
    • Exercise regularly.
    • Try to leave problems from home outside the OR doors so you can devote your focus to the task at hand in the OR. 
    • Take some time to mentally rehearse the surgery. Visualize key steps.