Student observers in the O.R...

shodobe · Oct 27, 2005

I will allow any and all students into my room to observe. I do not pick and choose procedures because I think it makes the the student feel they are not part of the team. We have enough problems attracting people into the profession without deciding what they can or can not watch. I mean, in med schools where everybody and their brother watch and gawk at patients in droves, what is the problem with a few students in the room. I have yet had one patient tell me they were uncomfortable with students in their room. All students sign documents to allow them into the rooms and all patients sign their consents, that states persons other than the OR team may be in the room observing for professional reasons. Patients that are awake before the procedure are asked, out of courtesy, if it is alright for students to observe their procedure, no problem.

Gompers, BSN, RN · Oct 27, 2005

I took a class like that in high school - it was called Medical Careers and it lasted one semester, for 2 class periods in a row. Three days a week we spent in the classroom learning things like medical terminology, taking vital signs and doing basic assessments, and types of jobs in the medical field. Two days a week we went to a local hospital and shadowed all kinds of different people. One of the things we did was spend two days each in surgery.

Aside from GYN, are there any other procedures you would prohibit high school students from observing?

I would say any high risk surgery like open heart or trauma wouldn't be a good idea. Maybe more of a routine surgery? Believe me, we were thrilled to pieces just to be standing in the corner of the OR! Our classmates were back at school running laps in gym class or taking math tests - and we were in scrubs, masks, and hats, watching actual SURGERY! We didn't care what the heck we saw, so long as they let us watch and once in a while explained to us what they were doing. Mostly it was stuff like lumpectomies, gallbladder removals, ortho cases, and scheduled C-sections.

Now, there were two guys that saw a man with testicular cancer have a testicle removed...I would say that would be a bad one for guys. They actually were so traumatized that they refused to talk about it later on. Poor guys!!!

grimmy, RN · Oct 28, 2005

i don't mind students watching in my room as long as they have been oriented thoroughly. i work in a big teaching facility, and we have students going through all the time. the only time i will keep people out of the doors is when things are not going well, and having extra bodies in the room makes more work for me. happened last week, as a matter of fact. some high school students are very mature, and others are definitely not. depends on the student, depends on the case.

sharann, BSN, RN · Oct 31, 2005

I will allow any and all students into my room to observe. I do not pick and choose procedures because I think it makes the the student feel they are not part of the team. We have enough problems attracting people into the profession without deciding what they can or can not watch. I mean, in med schools where everybody and their brother watch and gawk at patients in droves, what is the problem with a few students in the room. I have yet had one patient tell me they were uncomfortable with students in their room. All students sign documents to allow them into the rooms and all patients sign their consents, that states persons other than the OR team may be in the room observing for professional reasons. Patients that are awake before the procedure are asked, out of courtesy, if it is alright for students to observe their procedure, no problem.

I love your answer. We need to encourage future nurses not scare them off. Our paients are our priority of course, but we make adjustments for VIP's all the time, why not students?

carcha · Oct 31, 2005

We had this situation in one of the OR's I worked in some years ago and the student was asked to leave. I was happy with that decision. I personally do not agree with non professionals being part of such a critical environment. I can only hope that student nurses and doctors have been vetted as to how to behave in the Operating Room. Who vets the school children. I do not want school children in the operating room when I have to have surgery, I therefore will also respect other peoples dignity. As for patients not complaining I feel most people dont want to appear awful to the nursing and medical staff so dont complain. At those times we must step in.

SFCardiacRN · Nov 3, 2005

I think it is a good idea to encourage young people to enter nursing. If the patient gives permission AND the staff is comfortable with young students it is OK. Not every nurse is comfortable with this added responsibility and no one should be forced into it.

Cul2 · Dec 23, 2010

I realize this thread is 5 years old, but I'll post here hoping someone is interested in continuing the discussion. Frankly, I can't believe what I'm reading. High school students view surgery? Here are some thoughts/questions:

1. One poster wrote: "I will allow any and all students into my room to observe. I do not pick and choose procedures because I think it makes the the student feel they are not part of the team." Well, if they feel that they're not part of the "team" maybe it's because they are NOT part of any medical team. They are high school students. If asked, how many patients would consider a high school student observer as part of their medical "team?"

2. The same poster also writes: "I mean, in med schools where everybody and their brother watch and gawk at patients in droves, what is the problem with a few students in the room." Wow! What a great educational culture that encourages patient respect and dignity. Is that what doctors learn in medical school? I hope not.

3. Same poster again: "All students sign documents to allow them into the rooms and all patients sign their consents, that states persons other than the OR team may be in the room observing for professional reasons." First of all, all those documents those minors have signed, are legally worthless. Secondly, high school students, minors. have no "professional" reasons the be in an OR. They are not "professionals" in any sense of the definition.

4. Same poster again: "If I have GYN cases in my room, I don't allow any student observers during those cases." Yet, later on, everyone seems quite accepting of high school students observing testicular surgery. Do we have a little double standard going on here? Note here that the poster won't even ask the GYN patient her permission. It's just assumed that a high school student observer is never acceptable in this case. Yet it's open season on male surgery regardless of how personal it is.

5. What about the HIPAA laws? These kids are minors. They can't be held legally responsible for keeping any information private. Are the patients informed that there's go guarantee that these students won't reveal anything they want when they get back to school to whomever they wish and the hospital or anyone else won't be able to do anything about that, legally? How can the hospital possible monitor this situation?

6. Another poster writes: "Patients that are awake before the procedure are asked, out of courtesy, if it is alright for students to observe their procedure, no problem." First of all, "out of courtesy?" How about because it's their "right" to determine that kind of access? Let me get this straight -- Sounds like the patient is in the OR already, or at least gowned and ready to go. At that point, they are asked permission? And you consider that real informed consent? All set to go under the knife, naked and gowned? How about introducing the student to the patient while the patient still has his/her clothes on. Let the patient actually talk to the high school student who will be observing and ask him/her some questions.

This is a very disturbing thread. In fairness, there are only a few posts, so I'm not claiming that this opinion is the norm in the medical field -- but it could be. That's why I'm proposing to open up this thread again with the OP's original question, with the additional question as to whether high school students should ever be allowed to view surgery, and if so, how the patient's privacy rights will be protected, even if the patient agrees.

Editorial Team / Admin · Dec 23, 2010

I think allowing high school students to observe in the OR can be a good thing in certain circumstances. They should be seniors who are interested in going into the health field and want to check out the possibilities. Everybody and their brother, plus those who are not mature enough shouldn't be allowed. My hospital has what I think is a good policy on this- there is actually a form that must be filled out with who and why, and it must be approved by the nurse manager, the chief of surgery, and the surgeon who will be observed. There have been more denied than approved, and we rarely have high school students. Most of those who ask to observe are surgeons' children who are in med school, and I've even seen some of those denied.

canesdukegirl, BSN, RN · Dec 23, 2010

Of course, I encourage learning and love to have students in my OR. I think that the question of students observing should be posed to the patient during their last pre-op visit in the clinic, however. When a pt is in pre-op holding, gowned, IV started and ready for surgery, they are nervous. They already feel vulnerable. Most people would likely agree to this only because they don't want to make waves. You never know what's going through the patient's mind...like, "What if I say no? Will my care be worse because I did not want students in my room? Will they think that I am being unreasonable? Will they make fun of me while I am asleep?" This is the last thing a pt wants to worry about right before they roll into surgery. It may seem overbearing to them.

The maturity level of the students is a big factor. Someone mentioned something about HIPAA laws. The students have to sign a form regarding observation, which includes obeying HIPAA laws. While there is no guarantee that the students will actually honor this, is there a guarantee that employees will? The only difference is that if an employee breaches the law, they will be fired. There may be no repercussions for a student. It has everything to do with integrity and consciousness. I think at the senior level of HS, students have grasped this concept and will honor it, but who knows. Maybe I live in Mamby Pamby land.

Anxious Patient · Dec 23, 2010

As for explicit consent from patients allowing non-medical people in the OR, my hospital consent form reads "there may be people in training, or others, who will be in attendance or participating in your procedure...." very convenient wording to allow anybody or everybody in the OR with no obligation to volunteer details. At my hospital, a stack of forms are handed to the patient for signatures, rushed through just before the operation. Do you really think the nervous patient is reading through all the forms, let alone understanding all the legal wordery. Do you think any of them have a clue or even suspects what they are agreeing to? It's not like...Oh, you're going in for a gyn operation, that means medical students will be practicing pelvic/rectal exams on you while unconscious, do you approve?...

To avoid upsetting the patient with too much information (and possible patient refusal) consent forms are intentionally left vague to cover anything. Hospitals count on the patient not to challenge the consent because most patients are trusting, medically naive, and want to please.

This is anecdotal, my neighbor is hosting a foreign student who is here to learn about the American health system, specifically reproductory health. She was able to get a 2 week observation permit at a hospital. She attended gyn operations, births, sat in on patient exams, etc. She had to sign a HIPAA form, had to be in hospital attire with ID badge at all times (to blend in) and was discouraged from interacting with patients, particularly from revealing her non-medical status and her purpose for being there. She would be covered in the consent form under "others".

canesdukegirl, BSN, RN · Dec 23, 2010

Anxious-your story reminds me of a visiting doc from China. I am talking out of the side of my neck here, because I have never been to China and don't know the customs except from what I have read and watched on documentaries. We all know that space is an issue in China. It is crowded. The Chinese are not put off by personal space like we are in America. So while we are in the midst of our operation, the visiting doc leans so far into the sterile space that he is almost touching the back of the surgeon. I can't tell you how many times the surgeons had to drop scrub because his sleeve became contaminated while pulling on a retractor or simply reaching over to grab an instrument off the mayo while the scrub person was holding counter traction. We had to constantly watch this doc, and it took our focus away from other duties (like charting, stepping out to get supplies..we were afraid to leave the room). Our surgeons spoke to this doc several times a day about contamination and staying at least a foot away from the sterile field, but he never got any better. He could barely understand English, so I think that was part of the problem.

You also make a good point Anxious, when you state that the patients are handed a sheaf of paperwork prior to surgery and then ushered into the holding area with no time to read each and every line. I don't see how it is possible for a lot of our patients to understand what the consent really means, although it is glossed over by the registration staff. To their credit, the registration staff do ask the patients if they have any questions at all...but what do you think the response usually is? "Nope, thanks." The patient's main concern is if they will wake up from anesthesia.