Reading the Room: The Importance of Situational Awareness in the OR as a Medical Student

By Jovan Jande 

The operating room (OR) is a complex and unique environment unlike anything most individuals experience in everyday life. It is composed of people with distinct roles, complex monitoring systems tracking patient status, and actions that can carry life-or-death consequences. The anesthesiologist, positioned at the head of the bed, must constantly absorb this information and assess appropriate next steps. This process can be defined as situational awareness (Graafland et al., 2014). As a medical student interested in anesthesiology, demonstrating situational awareness
during your rotation is often more valuable than simply knowing the mechanisms of paralytic medications. Importantly, this is a skill that can be developed rather than an innate trait.

Several studies have highlighted situational awareness as critical for reducing errors and improving outcomes in the OR. A systematic review from the Netherlands noted that training in situational awareness can enhance safety, although surgical training often lacks explicit emphasis on this skill (Graafland et al., 2014). In a study focused on scrub nurses, a virtual reality tool demonstrated that error detection was highest among individuals with stronger situational awareness (Bracq et al., 2021). Additionally, in a review of anesthesia-related death and brain damage claims, failures in situational awareness were implicated in up to three-quarters of malpractice claims in these categories (Schulz et al., 2016). The research is clear: situational awareness is vital in the OR. So what can a medical student do to improve it?

Before the case, prepare thoroughly. Learn about the patient—their comorbidities, health risks, allergies, and more. Understanding their medical history can alert you to potential complications and help you respond appropriately if they arise. Similarly, familiarize yourself with the procedure. A laparoscopic cholecystectomy presents different challenges than a video-assisted thoracoscopy. Having a broad understanding of the case allows you to anticipate critical moments and recognize when to assist or step back to let the staff take over. Also, take note of the OR team and their roles. Responsibilities vary significantly—circulating nurses, scrub nurses, surgical residents, and anesthesia providers each have distinct domains.

During the case, remain vigilant and anticipate next steps. Depending on your comfort level, the complexity of the case, and your team’s willingness to involve you, your hands-on participation may vary. Regardless, attentiveness and anticipation will serve you well. Pay attention to monitors, understand the surgical phase, and stay aware of everyone’s positioning. This helps you identify how best to support the team. For example, if a bag of Lactated Ringers has finished in a volume-depleted patient, you might proactively bring another. However, if a patient has labile blood pressures and the team is struggling to place an arterial line, it may be better to step back and quietly assist—perhaps by handing the ultrasound probe to the resident physician. Thoughtful awareness of your surroundings will help you contribute meaningfully without disrupting workflow.

After the case, debrief with your resident or attending. Ask for feedback, particularly on how you might improve your situational awareness. Inquire whether there were moments you could have been more helpful, instances where you may have inadvertently been in the way, or areas where better preparation would have enhanced your participation. Rely on their experience and ask what strategies they use to maintain awareness during high-stakes situations. Situational awareness is not mastered overnight. Like most skills in medicine, it requires continuous practice and a mindset of lifelong learning. However, as a medical student on your anesthesiology rotations, cultivating this ability will not only help you make a positive
impression—it will also promote patient safety. Earlier, I described a scenario where a student might help by having the ultrasound probe ready during arterial line placement. I found myself in that very situation. Amid the urgency of a crashing patient, with both the staff and resident
anesthesiologists working to stabilize them, I stood quietly with the probe ready. It was a small action, but it was the right one. That is the essence of situational awareness as a medical student in the OR.

References

Bracq, Marie-Stéphanie, et al. "Training situational awareness for scrub nurses: Error recognition in a virtual operating room." Nurse education in practice 53 (2021): 103056.

Graafland, M., et al. "Training situational awareness to reduce surgical errors in the operating room." (2014).

Schulz, Christian M., et al. "Situation awareness errors in anesthesia and critical care in 200 cases of a critical incident reporting system." BMC anesthesiology 16 (2015): 1-10.