Importance of OR Etiquette and Professionalism

The NOTTS emphasizes the significance of operating room (OR) etiquette and the evolution of surgical culture towards a more respectful and collaborative environment. Key points include:

1. Changing Dynamics in the OR: The historical reputation of surgeons as being arrogant or demeaning, engaging in hazing practices, or displaying disruptive behavior is no longer acceptable. Modern surgeons are expected to create an atmosphere of mutual respect, trust, and communication.
2. Cultural Shift towards Respect and Safety: A culture of safety and respect in the OR correlates with improved patient outcomes. It also enhances team communication, fosters professionalism, and contributes to a positive educational experience for all involved.
3. Introduction to OR Etiquette: The concept of “OR etiquette” is introduced as a code of conduct among professionals that governs how they act and work together. This is distinct from manners, which are specific behaviors reflecting attitudes toward others.
4. Components of OR Etiquette: The chapter covers various aspects of OR etiquette, including communication skills, leadership and followership, giving and receiving feedback, and available programs for improving team communication and culture.
5. Team Members in the OR:

• Private Practice Setting: An attending surgeon, possibly with one or more assistants, which may include a second attending surgeon, certified surgical assistant (CSA), or physician assistant (PA).
• Academic Setting: Assistants may include medical students, residents, or fellows. Fellows are fully trained surgeons undergoing additional subspecialty training.
• Learning Environment: Progressive autonomy is a crucial concept, allowing learners to take on more responsibilities based on their competency level.

1. Preoperative Discussion: Clear communication between the surgeon and the team members before the operation is essential. This includes discussing roles, responsibilities, and educational goals for the case.
2. Patient-Centered Approach: Team members are responsible for reviewing the patient’s case in detail, understanding medical history, current disease status, medications, and diagnostic studies. A shared mental model of the operative and postoperative plan is crucial.
3. Intraoperative Focus: During the operation, the patient becomes the central focus. Each team member is expected to contribute to the progress of the operation and assist others in doing the same.
4. Postoperative Care Discussion: After the operation, discussions should cover postoperative care aspects, such as pain management, dietary restrictions, venous thromboembolism prophylaxis, and prescription medications.

The series posts (The Surgical Coach) aims to guide professionals in developing a positive OR culture through adherence to etiquette, emphasizing teamwork, respect, and effective communication for improved patient outcomes and a better working environment.