Theatre Etiquette Guide 2019

Theatre Etiquette Guide
Going to watch an operation is a daunting prospect. For many medical students a big part of this
barrier to entry are the often unanswered questions: Where do I go? When do I go? Where are
the scrubs? Oh sorry was I meant to get gloves BEFORE scrubbing in? Why are you shouting at
me for walking through the theatre doors? Etc. Despite this, theatres are a fantastic place to
visualise the anatomy and pathology that we spend so long reading about and are essential to
helping you discover which areas of surgery you enjoy the most. Even if you do not have a
particular interest in surgery at the moment you’ll never know until you give the operating room
a chance!
This article will address the following:
- Getting in to theatres
- Top Theatre Do’s and Don’ts
- Which operations should I try to attend?
- Top apps to help you:
- Elogbook
- Touch Surgery
- Appendix 1 - How to find the theatre list on EPIC
- Appendix 2 - How to access EPIC on your own device
Getting in to theatres:
In a perfect world, you would be able to do the following to attend an operation: At least
the day before the operation you would ask the consultant if they are happy for you to go to the
operation and what level of involvement you would be able to have. You would then get access
to the theatre list either by asking someone on the relevant ward, the consultant’s secretary or in
some hospitals by accessing it on the computer system and then prepare yourself to be vivad
on the relevant anatomy and pathology. On the day of the operation you would then arrive at the
theatre before the morning or afternoon team brief and introduce yourself to everyone involved.
In my and most people’s experience this rarely happens. Consultants can be elusive, theatre
lists can change, and other commitments like teaching can get in the way of your well
intentioned punctual arrival. So with that in mind what can you do?
1. Talk to the reg - They are normally a little easier to find than the consultant and in most
instances are very happy to try and help you get involved.
2. Do your best to get to that morning briefing - They might be early but having the chance
to show your face and let people know who you are will make it much easier to slip in
and out of the theatre if you have other commitments during the day.

3. Don’t be afraid to ask - If you do arrive and the operation has already started all hope is
not lost. Make sure that you’re wearing all necessary protective equipment (see our top
tips later on) and ask if it is ok for you to view the operation. Often there will be an ODP
(operating department practitioner - the people that help the anaesthetists mostly) in the
anaesthetic room and they can tell you who the anaesthetist and surgeons are before
you actually get in to the operating room itself.
Some practical tips:
Before going to theatres:
Ideally you should have had an induction to show you where the changing rooms and
where to go after that. If not, ask some of the FY1s attached to the relevant surgical team or
check with some other med students who have already been there. Policy varies between
hospitals about appropriate clothing so make sure that you ask someone at the theatre
reception for the low down if you didn't get an induction. Some hospitals have specific coloured
caps that students are meant to wear (in Addie’s it’s white), some hospitals are a little picky
about what shoes you wear while others are happy with you wearing any old trainers. Most
places will want you to be wearing your lanyard at all times and remember that the majority of
changing rooms are not very secure so best to leave any valuables at home or in a locker.
Getting in to theatres:
Layout of theatres varies massively between hospitals. Some have their own dedicated
anaesthetic and scrub rooms, some do not and knowing which door is safest to go through can
be very tricky. In general, in the morning or afternoon before the list has started it is safe to use
any of the doors. If in doubt, it’s normally safest to first check there isn’t a patient in the
anaesthetic room and go through there.
Knowing who’s who:
Operating theatres can be busy places and it’s important to know the roles of everyone
involved. In general, if someone is scrubbed they will have one of 3 roles. They will either be:
a) The scrub nurse - They prep all of the equipment and hand necessary tools to the
surgeon during the operation. They are normally very busy paying close attention to
what is going to be needed next so in general best not to try and disturb them.
b) The consultant surgeon - They’ll probably be doing most of the work that you can see
going on.
c) Registrar - Unless they’re being specifically taught something they normally take on the
role of assisting the consultant surgeon.
At the head of the patient will be the anaesthetist who may have a trainee with them. If not they
will often have an ODP somewhere nearby. There is normally also a number of other nurses
who do things like collect equipment for the scrub nurse and record swabs used. In addition to
all of these for certain operations there may be radiographers milling around and other people
might pop in and out like equipment reps, theatre managers and other surgeons.

At the end of the op:
While the surgeons are closing up and removing drapes this is often a good time to ask
any questions you might have had. You can make yourself useful by collecting the patient’s bed
from outside the theatre and helping slide the patient on to it under the guidance of the
anaesthetist. Depending on the efficiency of the theatre it may be a long time until the next
operation and once the surgery notes are completed the surgeons have a miraculous talent of
disappearing into thin air so if you want to follow them that day beware! If you do lose them the
anaesthetist can normally give you an idea as to when they’ll be starting again.
Theatre Do’s and Don’ts:
Definitely DO!
- Be careful with what equipment you need to have - It’s very unwise to march straight into
an operating theatre without checking first if you need any other equipment. For many
operations you will need to be wearing a mask before going in - when in doubt wear one
just in case, you can normally find them in the anaesthetic room. In some operations
lasers are used in which case special eye wear protection is needed while it’s very
common in orthopaedic theatres for X Rays to be used so lead vests must be worn.

The height of fashion ​- Top tip: The clip on the shoulder is very useful for getting
in and out of these monstrosities
- Dress appropriately - The temperature is controlled in most theatres but some people
can find it a little chilly just wearing thin scrubs so it can be helpful to wear a t shirt
underneath. Be careful if you are going to be scrubbed (and be wearing additional
clothing like a lead vest) because you can quickly overheat.
- Look after yourself! - You can be standing up for a long time in theatres. If you’re feeling
faint it’s far better to say you need to step away and get a drink than to pass out and
become a real nuisance for everyone.
- Make sure you can see - Standing around not being able to see what’s going on is a
waste of your time. There’s always steps around that you can position to look over
people’s shoulders.
- Get involved - Make the most of your time in theatres by being proactive and asking if
you can scrub in. You’ll learn new skills and the surgeons are more likely to teach you.
Even if you can’t actually assist scrubbing in means you’ll be able to stand closer to the
action and have a much better view. ​If your scrubbing in is a little rusty, ask one of us at
SurgSoc for when our next scrubbing in session is planned
Definitely DON’T!
- Enter a theatre without thinking first - You should never go in to the anaesthetic room
while the patient is being put to sleep and should never go through the main theatre
doors while an operation is going on.
- Touch anything sterile - Unless you are yourself sterile you should never touch any of
the blue/green sheets that are on and around the patient and the scrub nurse’s trolleys.
- Do something outside of your capabilities - The operating theatre is a great place to
learn but make it clear if you do not feel comfortable doing something.

Which operations should I attend?
This is obviously a very personal choice and will depend on your own personal interests but
below are some of the operations I would recommend and why:
- Laparoscopic cholecystectomy - A common operation where you can learn the basic of
laparoscopic surgery. There’s also the chance to see some important anatomy and learn
about gallbladder pathology.
- Total knee replacement - A good introductory operation to orthopaedic surgery that
doesn’t take too long but gives you the chance to learn about the principles of
arthroplasty.
- Robotic prostatectomy - See what some are calling the future of laparoscopic surgery
where the surgeon controls robotic arms performing the operation giving them an
improved range of motion.
- Cataract operation - The commonest operation performed in the NHS. Doesn’t take too
long and will give you a taste of ophthalmic surgery.
- Pulmonary endarterectomy - A very specialist surgery that you may be able to see
during your placement in papworth. Gives you the opportunity to learn about heart-lung
bypass.
Top Apps to help you:
Elogbook - ​This app allows you to track the operations that you attend and you can include it in
your portfolio for core training applications.
Elogbook symbol on the android store
Touch surgery - ​App with interactive video tutorials for a whole range of different operations
that can teach you the relevant anatomy and operation details.

Touch surgery app icon
We hope that this document will help you make the most of your time in theatres during your
time as a clinical student and beyond. If you would like some more help exploring an interest in
surgery we have other resources on our website including simple operation guides and
frequently run events such as knot tying and suturing sessions.

Appendix 1 - How to find the theatre list on EPIC
If you are on placement in one of the district general hospitals where they don’t use EPIC you
can try the following to find out theatre list you are interested in:
1. Ask foundation years or nurses on the relevant ward
2. At the theatre reception
3. Ask the consultant’s secretary
4. Some theatres have lists printed on notice boards
If you are based at Addenbrooke’s though you can look the theatre list up on EPIC:
1. Click on the ‘Epic’ button in the top left of your home screen
2. Go down to scheduling and then click on ‘Snapboard’ - this should bring up the theatre list

Appendix 2 - Getting EPIC on your home computer (Correct as of 2018)
This can be an absolute nightmare but is absolutely priceless once you have it. FIghting for the
sparse hospital computers in the library can be a thing of the past, instead do your SSC
research, access your addenbrookes email. check theatre lists and finish case write ups from
the comfort of your own home. See below on how to get started:
1. First off, make sure that you have access to your EPIC account. Why is this so
important? Well all of the documents that walk you through the process of getting
BYOD (Bring Your Own Device - The service that allows you to access all of the
hospital compute software from a device of your choosing) as well as the
registration form are only accessible through a hospital computer.
2. On the hospital computer search engine search ‘Accessing hospital computers
outside CUH’. Click the first link and it should be subtitled ‘Bring your own device
(BYOD)’
3. Near the bottom of this page click on the hyperlink that reads ‘BYOD pages on
connect’
4. On the next page that opens. Under where it reads ‘You must register your
device…’ click on the hyperlink ‘HP service portal’. Follow the instructions
beneath this link to register your device.
5. After submitting your application you should receive comprehensive instruction
documents about how to complete the set up.
Some points to keep in mind:
- After registration you need to set up your device to access the ‘BYOD wifi’ in the hospital
which can only be done within the hospital itself - it reaches the concourse so you can
always sit there and work through it
- You will need to install a certificate for your device and download the appropriate version
of ‘citrix receiver’ - this may take some trial and error as not every version of the software
appears to work on all devices.
- Once everything is installed you will be able to access the citrix storefront by following a
certain link that you will be given at the end of the process - I recommend bookmarking
this.
- You may not have access to the PACS system straight away - it may be that you need to
have an account created and approved for you before you can view radiological
investigations through EPIC.
For any issues that you come across your first and best port of call is the help desk:
Extension: 2757
Telephone: 01223216757
Email: ​cuh.itservicedesk@hp.com
They are normally incredibly helpful and will be able to solve most of your issues.