Top 10 Things Learned in Orthopedic Surgery – Adventures in PA Rotations |

Top 10 Things Learned in Orthopedic Surgery – Adventures in PA Rotations

Article reprint from – author is Timothy Loerke, a PA student in Fort Worth

If you are interested in surgery, and orthopedics is not on the list, you might want to reconsider. This field is packed with fun cases that require mechanical ingenuity, and the PAs are well utilized in the clinic and OR. Here are some of the things I learned over the past month.

1. History is everything. The surgeon would often stress how a good history will tell you everything you need to know. He encouraged me to first talk to the patient before looking at x-rays or reading the referral note. There is a sequence of events when making a clinical decision. It all starts with the patient.

2. “You’ve got to know how to talk to the ladies.” No, I did not learn how to be a chauvinist on this rotation. This was a funny saying my preceptor would often declare after treating fellow staff or nurses with respect. I know what he meant with that comment. Surgery can be a stressful place, and the first thing to go is the regard for others. It’s important to keep a sense of humor and respect for those around you.

3. Reproduce the demonstration. When we first learn a clinical procedure like casting, splinting or suturing, there is a sense of disconnect between the mind and hands. Students want to try and think it through or conceptualize how a certain technique works. I learned it’s best to simply mimic the one who teaches you and think about it later. My preceptor would often tell me, “I’m only going to show you this one more time.” Inevitably, he would have to teach me again because I would think too hard about it rather than do exactly as he did.

4. Show your patients confidence. A patient totally called me out when I was unsure about a splinting job I was doing. I may have been a little hesitant about the finished product and said some things that showed a lack of confidence. Patients pick up on our sense of self-belief. Thankfully the person had encouraging words in the end.

5. Your questions are answered by you. Each time I asked the surgeon a question, he would say, “You should know that,” or “That’s your assignment tonight and get back to me tomorrow.” I’m OK with that kind of teaching but it reminded me to continue being a self-learner.

6. It’s OK to say “I don’t know.” On the flipside, the surgeon would ask me questions and I would tell him, “You should know that.” Not really. I would actually rack my brain and either answer the question or make close guesses. If I was wrong, he would stop me and tell me to read about it. Rather than guessing, I learned to say, “I don’t know but I will get back to you tomorrow.”

7. Know your anatomy. This is important for all surgical rotations. You never know when the surgeon will pimp you or when you actually face a situation where the obscure facts are necessary. I’m pretty sure this will be a constant topic of review.

8. Think like a surgeon. It’s hard to teach students how to be a first-assist. The best way to learn is to think about the “problems” that face the surgeon that require an extra hand. Towards the end, I figured out that the field of view needed suctioning, not the random spaces. Also, retractors can be moved as the surgeon moves. You don’t always have to wait on the surgeon to adjust your hands.

9. OR etiquette. Each OR is different, but there are a few rules of thumb that seem consistent. Introduce yourself to everyone in the suite beforehand. Also, offer to pull your gown and gloves if they are not set out already. I learned the hard way a couple of times: “I am not your mama!”

10. Practice makes perfect. Don’t be discouraged by the amount of time it takes to cast, splint or suture. Remember that your superiors have been doing this a long time. It was not uncommon for my preceptor to finish closing so that we could stay on schedule.

My last rotation starts today! Check back next week to learn about my general surgery experiences. Thanks for reading!


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