Think you can handle it?

Every time a resident steps into the operating room he is tested. Whether it be how punctual he is, the way he positions the patient, the way he handles the scalpel, or the way he controls the suction as he pulls away diseased brain. Initially the attending does most of the case, and occasionally has his resident do a couple small things. Suck here. Tie this down. Cut this vessel. At one point or another the attending surgeon decides that the resident has proven himself, and lets him do more and more. Soon it becomes, "OK I'll do this side, you take care of that side." Before you know it, you're closing up dura without scrutiny, dissecting down paraspinal muscles without supervision, and closing up shop while the attending takes off for the day. I've only been left in the room to close up a couple times during residency, and usually just the superficial skin, but today the attending just threw in a couple stitches in the galea and said, "OK Won, you got this?" ... "Uh, yes sir." ... "OK good, thanks for your help." And he was gone.

Awesome.

It's really no big deal closing up scalp, and most residents probably wouldn't get very excited about it. But to have an attending leave the room while you operate, in this case close galea and skin, means they trust you to do a good unsupervised job at finishing the case and making sure the patient makes it to recovery without complication. Small accomplishment, but at least I'm heading in the right direction.