January Assessment

For the month of January, in lieu of meeting as a group, please spend some time responding to the following clinical vignettes.  A variety of issues are posed. You are to put yourself in the role of the attending surgeon and describe your decision to (or not to)  intervene as well as what you would do and when.

Optimal answers will clearly define

  • The problem/issue/challenge.
  • The scope and role of you, the surgeon, given the challenge.
  • Actions that should have been taken by you pre-surgery, that may have avoided the issue/problem from arising.
  • How to approach the issue now that it has presented itself.
  • Action(s) that you, the surgeon, should take now or in the future given the issue has presented itself and reasons for preferred action(s).
  • When to intervene or act.
  • Expected results of determined actions.

Please limit your response for each vignette to 100 words and up to ten bullet points.

  1. During the surgical time out, when the patient is prepped and draped, the circulator informs you that the patient consent form for the surgery is inaccurate.  The procedure to be performed is not correctly described.


  1. The scrub is clearly at odds with (and is speaking somewhat abrasively to) the new traveling nurse circulator who seems unfamiliar with the procedure and equipment needed for your procedure.


  1. On your morning rounds, a teenage patient tells you that he smokes a pack of cigarettes per day. You would not have done the elective procedure the day before, had you known this, because tobacco abuse can impact outcome of the procedure. In reviewing the intake form in the patient’s chart, he actually had checked “yes” to the question regarding tobacco exposure in the home.  It had not come up in the conversation with the patient in the office.


  1. You are the attending surgeon on call. Mid-way through a scheduled procedure you get paged that another surgeon in the OR down the hall is requesting your urgent intraoperative help.  You step out briefly with instructions to the resident and circulator on how to properly position and prep the patient.  When you return, the patient is prepped and draped, but the entire surgical site is not exposed and draped as you had instructed.


  1. During your operation a small (~2mm long 1mm wide) metallic part of an instrument breaks off in a patient. It resides in an anatomic place you think will not be harmful long term.


Please email your vignette responses to sarah.sarnie@childrens.harvard.edu