question from a surgical patient

TakeTwoAspirin, MSN, RN, APRN · Nov 27, 2007

You would be better off going directly to the facility that you had the surgery done at and ask them to explain their actions/reporting.

Anything anyone says here is going to be purely speculative, even given OR experience. As you went to the trouble of getting the op report from the facility you clearly are more than casually concerned with this matter and I am sure you would want a response that is more than speculative.

AilanMedici · Nov 28, 2007

You would be better off going directly to the facility that you had the surgery done at and ask them to explain their actions/reporting.

My operation was 8 months ago in another city. I have had no contact with anyone in the hospital since that time. I doubt anyone would remember anything even if I tried to contact them now.

And I'm not asking anyone to speculate on my operation, which by the way turned out fine. I hoped that by saying the operation was gynecological (hysterectomy) someone here could give me some examples of what a med student might be taught in the pre-op phase of the operation. My guess in the post-op phase was that they probably were learning how to suture. But I'm curious about the pre-op phase. And who better to have witnessed any of this than the OR nurses. I understand that the circulating nurse is supposed to be the patient's advocate. Unfortunately, I never met mine until I was being sedated. Even if I did have questions for her, there was no time or opportunity to ask anything. Besides I wouldn't have even known what questions to ask.

I am trying to decide whether I have my next operation in a teaching or community hospital. One issue I had with medical students is that during my 5 day stay in the hospital after my operation, many people came to my room identifying themselves as "doctor". After witnessing my nurse actually guiding these "doctors" through routine procedures with me, I questioned why these "doctors" needed assistance from the nurse. I was told later these people were actually medical students, not doctors. The nurses speculated that they called themselves doctors to put me at ease.

I don't want to approach my surgeon with general questions like "what do medical students do in the OR?" but rather more pointed questions like "do you allow medical students to...." (fill in the blank). But as I am unconscious in the OR, I don't know what's going on, so don't know what to ask. I want to be an informed patient, and hoped I might get help here from the people who actually witness OR events.

cardiacRN2006, ADN, RN · Nov 28, 2007

Pre and post op teaching is done on you.

GadgetRN71, ASN, RN · Nov 28, 2007

In my experience in the OR, med students don't really get to do anything. Maybe hold a retractor here or there. I can't speak for the OR you had your procedure in, but in mine, med students do not suture and they cannot identify themselves as Doctor. Residents can suture because they have graduated med school already. I wouldn't be too worried about the fact med students are present....they are watched like hawks by the attending, the circulator, the tech etc.

Pre-op teaching really just involves the diagnosis, any meds involved, anesthesia concerns. It involves more observing than anything else and involves the med student being quizzed on such topics. Community hospitals and teaching hospitalss both have pros and cons. Community hospitals may have a more cozy feel, but sometimes you get staff there that have been doing things the same way for years and they don't keep up on the newest treatments and protocols. Realize that at either type of hospital, you are going to have students(nursing, radiology etc).

brewerpaul · Nov 28, 2007

Yes, the pre and post op teaching is done on you as noted above. Part of the reason for mentioning it in the chart is to protect the hospital: if you ever came back with problems and said "Well, nobody ever told me I could have post operative pain" for example, they could pull up the hospital chart and show a trial lawyer that they did indeed tell you.

For our patients, we go over a written post-op instruction sheet with the patient and they sign at the bottom indicating that they were told these things. They get a copy and one stays in the chart.

al7139, ASN, RN · Nov 28, 2007

Hi,

I am a nurse, that recently graduated. I can tell you only my experience both on hospital units, and as an observer in the OR.

As students, we were assigned patients. We would then introduce orselves, telling the pt our name, and that we were nursing students from ___ school. We then informed the pt what we would do as students, and asked their permission to work with them that shift. Occasionally pts would not want to have a student, but most of the time they were fine with it.

If you are a student in any aspect of medicine, you must identify yourself as a student. Anything else is against the law.

Where I work now, we get med students, and they must identify themselves as a student to the pt. I cannot see how it would be different in an OR.

When I rotated to the OR, the students (in varied fields), were not always introduced to the pt, but they were only observing, not participating in the surgery itself.

The pre and post op teaching referred to in your report would most likely have been the OR staff teaching the med students what they do to prep a pt, and what they do after surgery, as well as teaching meds given, protocols and procedures.

I cannot say for sure, but you most likely consented to have students present for observation, not to participate.

My advice to you and anyone who gets medical treatment (surgery or not), is to ask lots of questions, and read the form before signing. As a patient, you have a right to know what to expect, and that includes knowing what the students persent will be doing. I never get annoyed with a pt or a family member asking these questions. Ask the hard questions. It is not unreasonable for you to know what to expect. Most med students observe for quite a while before participating, and then never without a surgeon present. They are usually close to graduating before actually helping in a surgery.

Hope this helps!

Amy

Anxious Patient · Nov 28, 2007

What about medical students being allowed to practice pelvic exams on anesthesized patients.

Couldn't that be included in the pre op teaching that the poster is questioning? Or is that still being done these days.

EricJRN, MSN, RN · Nov 28, 2007

What about medical students being allowed to practice pelvic exams on anesthesized patients.
Couldn't that be included in the pre op teaching that the poster is questioning? Or is that still being done these days.

Any teaching documented in the medical record would be teaching that was provided to the patient. We don't document what a medical student, nursing student, or other trainee was taught within a specific patient's medical record.

In the excerpt here, the charting is not ideal, but it sounds like medical students either led or assisted with the preoperative and postoperative instructions that were provided to the patient... or maybe that the nurse asked the medical students whether such teaching had been completed and they verified that it had (seems less likely to me).

core0 · Nov 28, 2007

I just discovered this wonderfully informative nursing forum. Perhaps you can answer a question for me.
I recently had gynecologic surgery at a California teaching hospital. Out of curiosity I accessed my operation report and one of the nurse's notes stated: "med students: pre and post op teaching done." No elaboration was given. Other than the vague paragraph in the consent form that stated "people in training may be present in the O.R." nothing specific was ever mentioned to me beforehand. I have no recollection of the O.R. as I was already anesthesized before entering. Can you give me an example of pre-op teaching procedures that might be done on female patients that would require it to be noted in the operation report.
Thanks so much,
Ailan

This really doesn't make any sense. I have never seen med students involved in pre or post op teaching. As long as we are guessing how about something completely different. Such as medications: pre and post op teaching done. This is much more likely. Lord knows I have written enough indecipherable notes in charts.

David Carpenter, PA-C