“Lesson” Plan for Surgeons – imagine if…

Imagine if every professional had to write plans, or context sheets for what they were going to do at work each day…. But perhaps other professions like doctors and bankers should be under the same, even more scrutiny, than teachers? After all I don’t think teachers kill people or send their countries into recession. Just a thought…

Dr's hands

Operation Objectives: Patient 1of 7- Female, 40 years.
To remove the brain tumour as one in timely fashionPatient to survive both the operation and for an extended time

To meet NHS targets for time and patient care

Operation Outcomes
Cancerous tumour is removed

There is little or no damage to brain from operation

Patient doesn’t die during operation

AFL: Assessment for Life (Signs) Opportunities
  1. Check patient is alive as we start, share a brief pleasantry with them as they succumb to the anaesthetic
  2. Check that team are alert and awake – shout a bit, threaten a few, make a joke or two, depending on who I am addressing and the time of the operation
  3. Check monitoring equipment for life signs – on-going
  4. Double check we have the right patient for the right operation
  5. Poke the patient to see if they’re still with us – from time to time
  6. Shout at someone again to make sure everyone is on their toes and no-one gets to die today
  7. Visit patient post-op to check they really did make it through in one piece
Differentiation
*Play different music at different stages of the operation to make me concentrate and/or feel good –sailing and water themes today, then heavy metal to conclude

*Rude and snappy to some of the team – especially the Surgeons-First lot (see below)

*Cheery and jokey with my trusted off-siders

Resources
State of the Art operating theatreLots of machines that go bip and flash from time to timeShiny sharp metal instruments

First class team

Decent sound system with music pre-programmed for the event

Health & Safety Issues
Two Surgeons-First people – “doctors” from Russell Group universities who have first class degrees (in History of Art and Mandarin) who are being fast tracked to be surgeons – need to keep them as far away from me as possible so they don’t distract or upset me such that I stab them with a scalpel instead of modeling outstanding practice (and/or let the patient die!)
Getting Down to It: The Operation ProperStarter: Get the Operation off to a Zippy start
*Check everything is ready, equipment, assistants, patient is prepped, scrub up

*Prepare a couple of jokes to set everyone at ease and be in positive frame of mind

*Ensure this is the right patient (always best to be safe than sorry- measure twice, cut once)

The Actual Operation (aim for 3 different activities)
Part 1 – Make incision at the specific area on the skull in order to locate and remove tumor, ensure I am in right spot – set music to soothing calm, beach like stuff today – Chris Rea, Australian Crawl

Part 2 – Double check all scans and information, ensure I have the right tools, proceed to remove tumor, taking all care to remove only the tumor and not cut, nick or damage anything else – a bit of Enya to help me concentrate – Orinoco Flow on repeat. Prepare to remove Tumor.

Part 3– Tumor removed, send off to pathology, brow mopped, sip of water – change music, some AC-DC – Highway to Hell and It’s a Long Way to the Top. Close and leave everything neat and tidy.

Plenary – consider the operation against the Operation Outcome
1. Ask the team how well they thought the morning’s work wentWWW – what went well in terms of the whole operation and in terms of your own role and othersEBI – how would what we have done today have been Even Better If … we had done what… (ie, what did we cock up?)

 

2. Evaluations and Reflection

Do you agree with others’ feedback

How will this help you/me

What have we learnt from today’s operation

Do you think this was useful task for us to complete today

*Make sure you all include this in your e-port-folio for evaluation and pay progression

Post Operative ActionsHomework
Remember to visit the patient in the ward, check their progress, make sure they’re happy with my work and not thinking about suing me or the hospital…
Surgeon’s Reflection on his work
All good.Tumor removedPatient alive

Didn’t lose temper with Surgeons-First twats

Should consider different play-list – but no time before the next op

doctor?

So, which is sillier, plans for surgeons for each of the operations on their lists for the day or for teachers to produce bits of paper like this to satisfy management, so we can prove we know what we are doing, instead of just doing it? (Images from Private Collection)

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