Your First Surgery as a Medical Student: How to Survive and Maybe Even Impress Someone

So, you’re finally stepping into the operating room for the first time as a medical student. Congratulations! You’ve probably imagined this moment since the first time you watched an episode of Grey’s Anatomy—scrubbing in, standing next to a world-class surgeon, maybe even making your first incision. But reality hits different. Instead of being the star of the show, you’re awkwardly standing in the corner, trying not to get in the way, while praying that nobody asks you a question.

The OR is a world of its own—hierarchical, fast-paced, and full of unwritten rules. If you want to avoid becoming the joke of the day (or worse, getting kicked out), you need to know what to expect and how to act. This is your survival guide to making it through your first surgery without fainting, fumbling, or frustrating the attending surgeon.

View attachment 61179
Wake Up Early, It’s Game Time

The first rule of surgery: if you’re on time, you’re late. Surgeons have the time management skills of fighter pilots, and if you waltz in right when the case is starting, you’ve already lost. The best approach? Show up at least 30-45 minutes before the scheduled time. This gives you time to:

• Check the patient’s case. Nothing screams "I’m unprepared" like not knowing why you’re in the OR. Read up on the patient, review the imaging, and anticipate the procedure steps.
• Introduce yourself to the team. The scrub nurse, the anesthesiologist, the residents—these people control your fate. A friendly introduction can go a long way.
• Find out if you need to scrub in. Not all surgeries require you to be in the sterile field. Sometimes, you’re just there to observe. Other times, you’ll get to assist. Ask in advance to avoid awkward moments.

The Scrub-In Ritual (Or, How Not to Get Kicked Out Before the Surgery Even Starts)

Scrubbing in is a sacred process. It’s a mix between a science experiment and an ancient ritual. If you mess it up, the scrub nurse will have zero hesitation in sending you out. Here’s how to get it right:

1. Scrub like you mean it. You’ll need to scrub from fingertips to elbows, using a sponge and antiseptic. Forget the lazy "quick rinse"—if a speck of bacteria survives, it’s on you.
2. Hold your hands up like a criminal. After scrubbing, keep your hands above your waist and don’t touch anything unsterile. If you do—back to square one.
3. Gloving and gowning: trust the nurse. The scrub nurse will assist you with putting on your gown and gloves. Just follow their lead. If you struggle, don’t panic—but also don’t touch anything. Let them guide you.

Finding Your Place in the OR Without Annoying Everyone

So you’re scrubbed in, gowned, and ready. Now what? Here’s what not to do:

• Don’t just stand there like a statue. Look engaged. Even if you’re just observing, follow the steps of the procedure mentally.
• Don’t get in the way of the scrub nurse. These professionals have the power to ruin your day. Stand where they tell you to. If you block their movement, you’ll get “the look” (and possibly verbal execution).
• Don’t lean on the sterile field. This might seem obvious, but you’d be surprised how many students absentmindedly brush against it. If you do, you’ll be unceremoniously sent out.

Holding the Retractor: Welcome to the Ultimate Endurance Test

Your first real job in surgery is usually to hold a retractor. Sounds easy, right? Wrong. This is a pain tolerance challenge disguised as a surgical task.

• You’ll be holding that thing for what feels like hours.
• Your arm will start shaking, and you’ll question all your life decisions.
• You can’t adjust your position—unless you want to hear, "Are you tired already?!" from the attending.
• The resident might "adjust" your positioning by shoving your hand deeper into the patient’s body. It’s not personal—it’s survival.

The key to success? Brace yourself, lock your elbow, and accept your fate. This is a test of endurance, not skill.

Be Ready for Pimping (a.k.a. Getting Questioned Like You’re in an FBI Interrogation)

Surgery attendings love to teach… by grilling you on anatomy, physiology, and surgical techniques in front of the whole OR. This is called pimping, and there’s no escape. Common questions include:

• “What are the borders of the inguinal triangle?”
• “What artery supplies this region?”
• “What are the layers you cut through during an open appendectomy?”

If you know the answer, say it confidently. If you don’t, don’t make something up. Just say, “I’m not sure, but I’ll read up on it after the case.” This is the least painful way out.

How to Avoid Fainting in the OR

Fainting during your first surgery is a rite of passage. The combination of nerves, long hours, and standing still for too long can do a number on you.

• Eat something before. An empty stomach plus bright lights equals disaster.
• Don’t lock your knees. This restricts blood flow and makes you pass out faster.
• Shift your weight subtly. Tiny movements keep circulation going.

If you start feeling dizzy, step back and say something before you hit the floor. Fainting into the sterile field is a career-ending move.

When Surgery Gets Intense, Stay Cool

At some point, something unexpected will happen—bleeding gets out of control, an instrument gets lost, alarms go off. This is the moment where you need to stay calm.

• Don’t panic.
• Don’t ask unnecessary questions.
• Just observe and learn—this is where medicine becomes real.

The End of the Surgery: Your Final Challenge

The surgery is done, the patient is stable, and you survived. But wait—don’t leave yet.

• Help with cleanup if possible. Don’t run out like a scared intern.
• If you scrubbed in, thank the team. The scrub nurse, the residents, even the anesthesiologist—they all helped you survive your first surgery.
• Ask for feedback. If a resident gives you advice, take it seriously.

Final Thoughts: Surgery Is a Marathon, Not a Sprint

Your first time in the OR won’t be perfect. You’ll make mistakes, you’ll feel lost, and you’ll probably embarrass yourself at least once. But that’s okay. Every surgeon you admire was once in your shoes.

The key is to show up prepared, stay humble, and keep improving. One day, you’ll be the one leading a terrified med student through their first surgery. And when that day comes, remember how you felt today—and make it just a little easier for them.