4 Things I Do the Night Before to Prepare For a Case

Checklist to prepare for a case the night before

An attending surgeon once told me that the difference between a good resident and a great resident was the time they put in outside the operating room. 

So, I’ve developed my own routine for preparing for cases that is both efficient and effective.

I follow these four steps the night before. 

1. Basic review. 

Task number one is always going to be reviewing the anatomy and basic steps of the procedure. A good surgical atlas kills two birds with one stone, as it can both help you understand the anatomy and walk you through the surgical steps. Find a surgical atlas with a flow of illustrations and a level of detail that you like and stick to it. 

At the end of this task, you should be familiar with not only the anatomy in front of you during every step, but also the danger structures around you. When dissecting out the inferior pulmonary vein, what structures are around it that need to be avoided? When throwing aortic valve replacement stitches, what structures could be damaged with a suture thrown too deep in the right coronary annulus?

Bonus: Take notes! Especially if this is a new surgery to you. Without getting bogged down in the details, know the order and major steps of the case. If you can do this on a cloud-based app, you’ll be able to quickly review it at the scrub sink before you start. 

2. Watch videos. 

Believe it or not, YouTube is probably the most important step in this entire process. There are so many amazing videos of step-by-step instruction of almost every surgery imaginable that will also help you understand the anatomy. Once you find a video that is helpful, save the URL in your notes for that procedure so you can re-visit when you need to review this surgery in the future. 

Bonus: for robotic surgeries, most ORs are equipped to record video. Reviewing “game film” is a great way to learn specific ways attendings perform cases and also ways to improve your own techniques. 

3. “Chair flying”

In flight training, chair flying is a common technique where you sit down and, without any prompts, review - either in your head or out loud - all the major steps needed for a successful flight: the speed needed to take off, when to retract flaps, etc. Much like in surgery, these steps need to be second nature to assure a safe flight. 

Chair flying through the surgery will help you and memorize the steps of the procedure. When operating with an attending, you should be able to move from one stage of the operation to the next without prompts. Knowing the flow of the surgery will make your attending more confident in your competence and will likely result in more operative autonomy. 

4. Low-fidelity simulation. 

The final step is the most fun. Spend 10-20 minutes on low-fidelity simulation. At the beginning of training, this may be simple knot-tying or practice drills on the DaVinci robot simulator. As you advance in training, there are plenty of simulation tutorial set-ups available online: you can use anything from balloon-animal balloons to exercise bands and a hole puncher to practice anastomoses. 

Bonus: chat with your co-residents and try to figure out how your attending does specific things. Do they use two purse strings for their aortic cannulation sutures? Is it a back-handed throw? Practice the exact movements you will be performing tomorrow and start building that muscle memory. 

If you follow these basic steps, you are guaranteed to be prepared for every case - and that confidence will show. 

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Lee West is a PGY6 UAB cardiothoracic Surgery fellow.

The opinions expressed in the article are not affiliated with any institution, company or product. The article should not be interpreted as medical advice.

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