A medical student’s first experience of theatre

Disrupting the neat choreography and finding my part in it

After weeks of trawling through abstracts and entering data into Excel spreadsheets for a summer research project, my supervisor asked whether I would like to go into theatre to watch a thyroidectomy. Of course, my heart leapt at the thought. As a first year student, I had never been into theatre so I had no idea of what to expect. I wondered whether watching all of Grey’s anatomy would help and whether my anatomy knowledge would be up to scratch.

I was told to arrive at 6 am outside the change rooms, much too early for me to fit in breakfast. The consultant told me to meet him on the other side and, in my hurry to not hold him up, I put my scrubs on backwards and left my name tag in my bag. At last, I came out the other side feeling confident and ready for action. The start of the surgery was like a ballet, from the elegant pirouette of the surgeon as he spun around to put on his gown to the blinding theatre lights and the exact positioning of everyone in the room — not a centimetre out of place. I had an awful sense that I was disrupting this neat choreography.

The consultant ushered me closer and told me to place my hands on the patient. Next, he told me to switch positions with the registrar so that I could hold a retractor. I stood like a statue, petrified that I might do something wrong or get in the way. I became fixated on the carotid artery, red and pulsating. I felt terrible. I had never fainted before but I felt as though I was going to. I became acutely aware of the beeping of the monitors and the smell of burning flesh. I looked at the scrub nurse but could not articulate what was going on. She seemed to know and calmly grabbed the instrument off me, while I inched slowly backwards towards the wall. I did not actually lose consciousness but the anaesthetist told me to go and have something to eat. Why did I not have breakfast?

The anaesthetist found me in the kitchen. I was so embarrassed about what had happened. He reassured me that at least once a month a new student faints and that, in fact, I had done an excellent job of recognising the signs and walking away from the table so as not to cause any distraction. He told me I had a decision to make. I could go home or I could come back for the next operation. I decided I should to do just that and followed him back inside. I successfully watched three more thyroidectomies without any problem. I was also pleased to learn that the surgeon did not even know that I had left the room.

Early emotional experiences in the theatre can have a detrimental impact on students’ learning and future career choices. Interviews of medical students carried out by Bowrey and Kidd1 suggested that negative feelings surrounding the theatre were common and included concerns about violating theatre protocol as well as a fear of syncope. Jamjoon and colleagues2 reported that 12% of penultimate and final year students experienced near or actual syncope in the theatre and 9% reported being discouraged from pursuing a surgical career by a syncopal episode. The study found that the most useful measures that students could employ to avoid syncope were eating before the surgery and leg movements when standing for prolonged periods.

It is common for medical students to feel anxious about new clinical experiences and their first time in theatre is no exception. In an attempt to foster a positive learning experience, some Australian universities have introduced “surgical skills” as part of their first or second year programs. In these sessions, students learn to scrub in an environment where they feel comfortable and supported. They may also participate in mock theatre demonstrations and explore the role of each member of the surgical team. Students who feel knowledgeable about sterility, surgical attire and the surgical environment before they enter theatre will be more confident and able to focus on their learning. Before the surgery, students can prepare by revising the patient’s condition as well as the planned surgical procedure.3

Orientation days at teaching hospitals could provide students with the chance to familiarise themselves with the operating theatre environment before they attend a surgery. Staff can help remove the stigma around syncope by directly raising the issue and suggesting preventive measures. It helps if they are approachable and encouraging and make students feel socially included within the theatre team.2 These strategies may ensure that students are well prepared and have a positive learning experience.

In theatre, students will learn more about anatomy than they ever could from a cadaver or a textbook. They are able to put their theoretical knowledge into practice and observe the treatment of a condition from start to finish. They begin to appreciate the unique relationship of trust between the patient and doctor and the importance of working well within a team. In teaching students, supervisors should reflect on their own early clinical years and be mindful of their ability to inspire a love of surgery in the next generation of doctors.

On a personal note, I have realised that there is no need to be embarrassed about what happened during my first experience of theatre and that I can learn much from it to inform my clinical years. However, it was certainly an experience that I will not forget.