How to Prepare for Your First OR Days and Busy Clinic Schedules

“The will to succeed is important, but what’s more important is the will to prepare.”

—Bobby Knight, former Hall of Fame college basketball coach

After you complete your training (and go on a well-deserved long vacation), I’d recommend taking the extra effort to prepare for your first job. 

Feeling prepared will help alleviate anxiety, minimize complications, improve your efficiency, and set a strong foundation for your future.

9 Ways to Optimize Your Surgical Success

1. Organize your surgical videos and notes from training. Although tips for white cataracts may be obvious now, you may feel differently when you don’t operate on one for months after training. Write out steps and tips for procedures while it is fresh in your mind. I recommend using an app that you can access/edit on both your computer and your phone (such as Google drive or Apple notes). You can also take pictures of suture packages or surgical instruments and make a folder in your photos on your phone.
2. Anticipate surgical decision-making. Instead of rethinking surgical options for each patient, try to determine your surgical preference for each common scenario.  Would you prefer a primary tube or trab for uveitic glaucoma? When would you put in capsular support in a patient with pseudoexfoliation? These personal choices may be based on experience, anecdotes, or evidence. Committing to an answer (a tentative one at least) will make things easier and quicker when the patient is in front of you. 
3. Prepare a pre-surgical/consent template for each major procedure in your electronic health record (EHR) system. This should include standard documentation as well as surgery-specific risks to discuss, and exam findings to note. Consider having a special section to communicate with your surgical coordinator. Use templates from your mentors or colleagues as a foundation when possible. 
4. Don’t forget that you can call your patient at a later time. Complicated or difficult patients will often throw you for a loop. It’s OK to tell the patient you will call them to continue the conversation at a later time — this can prevent falling behind in your schedule while also giving the patient the time they deserve. In some cases, it also gives you time to think through a complex scenario and even phone a friend or mentor for advice. 
5. Review your surgical cases at least a week in advance, if possible. You may uncover a need for a patient to get repeat lens calculations, obtain an anti-VEGF injection or start steroids prior to surgery.
6. Write yourself patient-specific tips for the day of surgery when consenting or reviewing charts. For example, “Give mannitol pre-op” or “Place patient in reverse Trendelenburg.” When you look up a video for an upcoming case, also keep a link to it handy — such as in Google docs —so you can refer to it quickly when you need it.
7. Plan for a good night’s sleep before the day of surgery and eat a good breakfast.
8. After your surgical cases, revise your Google docs with any new feedback for yourself.
   Note any difficulties you encountered, or any adjustments you may have made.
9. Don’t forget to treat yourself after!

Give yourself a pat on the back. 

5 Ways to Optimize Your Success in Clinic

1. Set your expectations. Also be sure to check how they align with your practices’ expectations of you in terms of patient volume and flow. 
2. Optimize your technician workup. Communicate with your staff about what is important for your technician workup for clinical and billing purposes because this may be different among specialties and doctors.
3. Positive reinforcement goes a long way. Prioritize developing positive relationships with your team. Make sure you tell your staff members when they’ve done a good job.
4. Do a daily or weekly team roundup after clinic. Briefly discuss what went well and what could have been better from everyone’s perspective. If you do this routinely, it will be less awkward when pointing out ways to make improvements for the system as a whole or with a person directly. 
5. Understand and improve upon your patients’ experience outside of the examination room. For example, how much time does it take for patients calling the medical office to get a live person, obtain a follow-up appointment, or request a refill? How can this be improved upon? 

Your success as a physician depends not only on the care you provide your patients, but also on how well you communicate with clinic staff and manage your schedule. Be open to change and adapt within reason. This will send a powerful message that you care about the health of the practice as well as that of your patients.

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Natasha Nayak Kolomeyer, MD, is a glaucoma specialist at Wills Eye Hospital in Philadelphia. She joined the YO Info Editorial Board in 2019.