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