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
  • PGY 1
  • PGY 2
  • PGY 3

  • Collaboration and teamwork

    • Recognise the roles and responsibilities of other professionals within the healthcare team; respect and listen to their concerns about the patient
    • Understand both personal and collective responsibility within the team to ensure the safety of patients
    • 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
    • Can explain indications, contraindications and risks involved in decision making regarding common procedures
    • Recognise personal limitations and ensure appropriate supervision
  • Leadership and management
    • Respond positively to direction
    • Take responsibility for any task delegated
  • Medical expertise
    • Practise hand hygiene, noting standard precautions, transmission-based precautions, personal protective equipment and aseptic technique
    • 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
    • Maintain an appropriate standard of professional practice and work within personal capabilities

  • Technical expertise

    • Undertake training through a combination of simulation and direct supervision
    • Perform some generic elementary technical skills

  • Collaboration and teamwork

    • Anticipate patient care needs and communicate these to other members of the team
    • 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
    • Can explain the common conditions of the unit effectively to patients and undertake informed consent for common elective and emergency conditions
    • See College position paper for Informed Consent and the Medical Council New Zealand statement
  • 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
    • Use mechanisms that minimise error, e.g. clinical checklists, Surgical Safety Checklist, handover protocols, unit protocols
    • 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
    • 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
    • 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

  • 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
    • 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
    • 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
    • Respond positively to suggestions for performance improvement

  • Scholarship and teaching

    • Adapt level of supervision to learner’s competence and confidence

  • Technical expertise