Plan/participate in the operating room journey

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently plan and/or participate in the operating room journey.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3.  The doctor is encouraged to download the key clinical task guidelines  and seek the support of his/her supervisor for feedback on performance.

  • Relate diagnosis to the surgery
  • Arrange pre-operative tests/workup/preparation
  • Facilitate informed consent
  • Participate in WHO checklist/pre-operative brief
  • Participate in positioning of patient
  • Preparation and draping
  • Assist/perform surgery under supervision
  • Document procedure/post-operative care
  • Communicate with family/staff/ICU/HDU

Related Competencies:

Collaboration and teamwork

Recognise the roles and responsibilities of other professionals within the healthcare team; respect and listen to their concerns about the patient
Collaboration and teamwork

Understand both personal and collective responsibility within the team to ensure the safety of patients
Collaboration and teamwork

Inform the presence or availability of team members to patients

Communication

Communicate effectively with patients to take clinical history
Health advocacy

Advise families and carers according to the patient’s condition and wishes

Judgement and clinical decision making

Identify the common clinical conditions managed by the clinical unit and be fully conversant with the clinical knowledge, key decision-making points and issues that influence decisions within these conditions
Judgement and clinical decision making

Can explain indications, contraindications and risks involved in decision making regarding common procedures
Judgement and clinical decision making

Recognise personal limitations and ensure appropriate supervision
Leadership and management

Respond positively to direction
Leadership and management

Take responsibility for any task delegated
Medical expertise

Practise hand hygiene, noting standard precautions, transmission-based precautions, personal protective equipment and aseptic technique
Medical expertise

Follow stages of a verification process and comply with the organisation’s procedures to ensure correct identification of a patient
Professionalism

Demonstrate empathy, caring and compassion for patients, their families and carers and treat them with dignity and respect
Professionalism

Maintain an appropriate standard of professional practice and work within personal capabilities
Technical expertise

Undertake training through a combination of simulation and direct supervision
Technical expertise

Perform some generic elementary technical skills
Collaboration and teamwork

Anticipate patient care needs and communicate these to other members of the team
Collaboration and teamwork

Participate in shared decision-making activity involving patients, families and relevant health professionals, such as development of a care plan noting reference to open disclosure in ‘Communication’ section
Communication

Use a range of strategies to involve patients in discussions and decisions about their care, including presenting options and clarifying understanding. This should lead to recommendation and decision about management
Communication

Can explain the common conditions of the unit effectively to patients and undertake informed consent for common elective and emergency conditions
Health advocacy

Identify key issues on which to advocate for the patient to ensure their immediate clinical care and requirements are achieved
Judgement and clinical decision making

Identify and justify patient management options for common problems and conditions
Judgement and clinical decision making

Use mechanisms that minimise error, e.g. clinical checklists, Surgical Safety Checklist, handover protocols, unit protocols
Judgement and clinical decision making

Select appropriate procedures, with involvement of senior clinicians and the patient
Leadership and management

Able to ensure that ward patients are ready for theatre on time
Medical expertise

Work within unit-based protocols with regard to pre-operative assessment and care, operative procedures and post-operative care:

  • apply medical knowledge to clinical practice
  • implement and evaluate a management plan relevant to the patient following discussion with a senior clinician
  • identify when patient transfer is required, and manage risks prior to and during patient transfer
  • recognise indications for, and risks of, fluid and electrolyte therapy and blood products
  • provide appropriate aftercare and arrange follow up for common procedures 
  • safely manage anti-coagulant therapy and manage diabetes
  • recognise acute cardiac events and use relevant resuscitation/drug protocols
  • initiate resuscitation of the unwell patient. Recognise indicators for sepsis and implement clinically relevant plan
  • maintain a clinically relevant patient management plan of fluid, electrolyte and blood product use
  • recognise and manage fluid and electrolyte imbalances in a patient
  • effectively use semi-automatic and automatic defibrillators
  • provide appropriate aftercare and arrange follow up for more complex procedures
  • recognise when patients are ready for discharge and arrange referral to relevant members of the healthcare team to promote planning for safe discharge
Medical expertise

Safely prescribe use of antimicrobials and be aware of the influence of the pharmaceutical industry. Clearly understand proper surgical prophylaxis and distinguish this from therapeutic use of antibiotics for bacterial infections
Medical expertise

Prescribe pain therapies to match the patient’s analgesia requirements. Be empathic when managing pain and review outcomes when prescribing
Professionalism

Critically reflect on own performance and make an accurate assessment of this
Technical expertise

Engage with Basic and Intermediate surgical constructs
Collaboration and teamwork

Collaborate effectively with other specialist teams involved in the patient’s care

Communication

Obtain fully informed consent for common elective and emergency conditions

Communication

Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management
Health advocacy

Advise patients (and their families and carers) of relevant risks of options
Judgement and clinical decision making

Use investigation findings to refine diagnoses for common conditions
Leadership and management

Remain calm under pressure
Leadership and management

Delegate appropriate tasks to junior members, ensuring supervision is maintained
Medical expertise

Be aware of risks associated with common conditions and procedures and implement steps to predict or mitigate them
Professionalism

Deal with ethical uncertainty and conflicting values; maintain ethical standards
Professionalism

Respond positively to suggestions for performance improvement
Scholarship and teaching

Adapt level of supervision to learner’s competence and confidence
Technical expertise

Able to demonstrate that basic essential surgical skills constructs are well established
Technical expertise

Competent with intermediate and many of the advanced Essential Surgical Skills constructs

The JDocs website is an initiative of the Royal Australasian College of Surgeons.

The aim is to provide career guidance to junior doctors in Australia and Aotearoa New Zealand during the early prevocational years.

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