01/15/2026    Allen M. Jacobs, DPM

Lessons Learned From My First Time in the Operating Room

The commentary regarding the preparation of a
resident for surgery is important. However, there
is the other side of the equation: the role of the
attending. Ultimately, the goal is to graduate a
resident that will have the confidence to perform
surgery independently. We have a responsibility to
the resident as they have to the attending. I have
devoted my life to the education of students and
residents and would like to share some thoughts.

A pre-operative discussion is critical. What
factors did the attending consider in making the
decision to proceed with surgery? What are the
intended goals of the surgery? In what manner is
the surgery planned to be performed? What are the
intended goals of the resident for the case? Are
you prepared to offer constructive feedback
following the case? Are you prepared to encourage
the resident? Are there anticipated "critical
times" during the procedure which require special
consideration and additional plans?

Following the case, do you debrief the resident?
Do you evaluate their situational awareness? Their
decision making? Their technical skills? Do they
orchestrate the operating room and communicate
with patients and staff effectively?

I always encourage residents to review the
literature following the surgery as I believe it
has greater relevance at that time to think about
the procedure. Yes, I wish them to prepare before
and will ask appropriate questions. However, have
completed a procedure, I believe reading after the
fact is very helpful in putting things where they
belong.

Residents want honest feedback to grow. In the OR,
resident autonomy and the chance to struggle is
important. Patience is important. Intra-operative
teaching is important, especially when teachable
moments arise. Follow the Zwisch model of surgical
education: Step 1, show and tell. Teach as you
work, think out loud. Step 2: smart help. The
resident participates with your ongoing direction.
Step 3: dumb help. Let the resident work and
struggle a bit-but jump in when required. Step 4:
no help. Let the resident work and shut up (very
difficult essentially impossible for me).
I study the teachings of Sir William Osler. And
like him, "I desire no other epitaph...than the
statement that I taught students in the wards, as
I regard this by far the most useful work I have
been called upon to do".

Residents are much more than a variety of
indentured servants. They are our professions
future and our charge. Treat them accordingly.
There is no greater gift than sharing your
experience and understanding and knowledge with
them.

Allen M. Jacobs, DPM, St. Louis, MO

Other messages in this thread:

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01/15/2026    Mark Wolpa, DPM

Lessons Learned From My First Time in the Operating Room (Howard Zlotoff, DPM)

After reading Dr. Zlotoff's memorable experience,
I was reminded of mine that I have not thought
about in many years, but still break out in a cold
sweat reliving it.

As a first year resident at the California
Podiatry Hospital in San Francisco we were
required to take call and stay overnight at the
hospital. Back in the days when dinosaurs roamed
the streets, patients having surgery checked into
the hospital the night before and we would work
them up before their surgery the next day. My
surgery schedule had me in the operating room with
an attending who was very generous with residents.
If the case was B/L, the resident was guaranteed
to do a foot. The case I would be scrubbing was a
B/L bunionectomy. This was at the beginning of my
program and I was very excited to add to my very
limited case numbers.

The night before the surgery I was called in the
middle of the night to deal with a patient in the
hospital and did not get back to my room until
early AM. I called the hospital operator to give
me a wakeup call at 6 AM so that I would have
plenty of time before surgery.

I remember rolling over, looking at my watch which
read 7:27 AM! I never got a wakeup call and I was
panicking running to the OR. The feeling I had was
worse than the feeling of passing a highway patrol
hiding in bushes on the road and watch them pull
out behind you in your rea view mirror, and then
turn on their red light! As I got to the sink to
start to scrub the attending was putting on the
stockinette and elevating the leg, that was
supposed to be my job.

I am staring into the room scrubbing harder as if
it would make the time pass quicker, when my eyes
met the attending and he unleashed a hot laser
stare that went right through me , he then shook
his head no.

I dropped my brush and went into the room , and in
the middle of apologizing and explaining that I
was up in the middle of the night dealing with a
hospital patient, he stopped me and calmly said,
"A 7:30 start time is not just a suggestion.

Have a nice day!"

I was crushed and walked out of the room only to
encounter my fellow residents who knew I was
scrubbing with the attending who loved residents,
and had to answer their question of “So how did it
go?”

Lesson learned. I was never late again.

Mark Wolpa, DPM, Palm Desert, CA

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01/14/2026    Howard Zlotoff, DPM

Lessons Learned From My First Time in the Operating Room

Dr. Santiago’s article about preparation before
going into the operating room reminds me of an
experience I had 45 years ago. I was one of twelve
first-year residents at the Northlake surgical
program directed by Lowell Weil, DPM in a Chicago
suburb. From these twelve, two were selected to go
on to become second-year residents, me and Don
Arenson. We were thrilled and our egos were puffed
up as we strutted around the hospital.

My first week as chief resident, I was scheduled
to scrub-in with Dr. Weil to assist to perform an
Evan’s calcaneal procedure. As Dr. Santiago
mentioned, I thoroughly prepared the night before
and read how to do the procedure. Avoiding vital
structures, creating the proper bone cuts to
effect correction and then fixate the osteotomy
with bone staples were branded into my brain.

The patient was anesthetized, prepped, and the
tourniquet was inflated. I marked the skin with my
intended incision. Just before the 10 blade
touched the skin, Dr. Weil stopped me and asked
“Zlotoff, how many degrees of motion will be lost
by the subtalar joint after this procedure is
done?” I had no clue because my preparation was so
focused on the mechanics of the procedure that I
never paid attention to the result. I looked up
over my mask at Dr. Weil and said I didn’t know.
He calmly took the blade from my hand and
proceeded to perform the entire procedure himself
as I held retractors for the next hour. He never
said another word about it and nor did I but of
course after the operation, I looked up the
answer, which was 50%, and then I went about with
my daily assignments.

To this day, I have NEVER forgotten that answer! I
learned a valuable lesson from a great man who
became my mentor, friend, and hero in later years.
So as in life, preparation for any new adventure
is a great asset as we pursue new experiences.

Thanks for publishing Dr. Santiago’s letter. We
should all heed her advice.

Howard Zlotoff, DPM, Mechanicsburg, PA