Awareness is the ability to recognize and appreciate the reality of a situation. This is a useful skill whether in public, social settings, the operating room, or dark alleyways. Unfortunately it is a trait students sometimes overlook, thinking their academic prowess and hard work will cover for their social deficiencies. It's not unique to students; being socially awkward is in vogue. While it is true being a social butterfly is not requisite to success in medicine and academia, a little awareness goes a long way. During the course of medical school, I spent a month with the pediatric general surgery service. It was my very first clinical rotation outside of the classroom setting and it was striking to experience the real-time, intense thrill of being in the operating room as it required immense effort from the learner intellectually, physically, and socially. I share some of my lessons learned here.
Stay awake and stay alert
Staying awake is critical to your success. One of the challenges of the surgery rotation is the hours; days start early and end late, making sleep a commodity. Your goal is to be engaged and you want people to recognize you as a student who is engaged. Being engaged is a rare quality because there are so many students who brush off opportunities and activities as unimportant and spend their time multitasking on their electronic devices. Nobody will say anything to you directly, but everyone is silently forming their opinions. Paying attention to what's going on in front of you shows you want to be there and shows a respect for the people around you. The easiest way to sabotage yourself is to fall asleep, space out, or multitask during meetings, conferences, or surgeries.
Being alert means you're paying attention. During a surgery, the first time everything will be new, but the more you pay attention, you will recognize patterns. Predict the needs of your team. Predict what's happening next. As the medical student, you can help by cutting sutures, so reaching for the scissors as surgeons are tying off knots and putting them down when the cutting is done shows you're paying attention. One attending surgeon commended me saying I was good at paying attention and remarked that most students can't even do that. I was a little dumbfounded because all I was doing was cutting strings, but I was happy to hear it.
As you pay attention more, you will realize when you can ask a question and when you should stay silent. This is the art of reading the room. Many socially awkward people have trouble reading the room. They never know if they should say hi to someone or when it's time to leave a gathering. The tip is to sit back a little and observe. Try to mirror what everyone else is doing. When the room is silent, this is your time to be silent. Don't fill the void with your voice. When the room is easing up and the team is bantering over music genres, that's your cue that you can speak a bit. Observe first and then make your move.
Don't take things personally
Surgeons have this feedback-based approach to learning. Surgery is a procedural skill and a large amount of learning is done in real time as the surgery is happening. If they see you doing something wrong, they will correct you. This is how surgery is taught. In everyday life, we freak out if someone we don't know well tries to correct us and we take it personally believing the one advising us hates us. We may even start to avoid them, trying to avoid future conflict. Don't do that. Consider it a compliment that someone whose time is so important took a moment to teach you something worthwhile.
Never make the same mistake twice. The first time you make a mistake, the surgeon will correct you because it's their job to protect the patient and ensure things are done properly. One of the first times I came into the operating room, I accidentally walked in without a mask. The surgeon turned around to see who entered and said sternly, "Please wear a mask." I went right back out. I felt bad at making a mistake and half-considered finding another operating room to visit, but I just came back in with a mask. Later I apologized and the surgeon said not to worry about it. I assure you, surgeons do not spend their day thinking about the small mistakes medical students make. However, don't make the same mistake twice because while the first one is taken lightly and almost always forgiven, the second mistake shows a lack of respect and seriousness in the student.
You aren't the center of attention
You have to understand you are in the operating room to learn. The surgeons are in the operating room to perform a surgery. You may enter an operating room and during the whole surgery, the surgeon doesn't say a word to you. You may feel invisible and perhaps sad, but you have to recognize you are not the priority in the room and you have to be okay with it. It is such a privilege just to stand at the table and observe the procedure. Even if you're not able to scrub in, it's still a privilege to listen to the surgeons' conversations and look over people's shoulders into the surgical field. There's learning in that too, so you should never feel upset that you weren't treated like a first-class citizen where the whole surgery stops so that everyone can turn toward you and point out the structures and explain what's going on. You have to recognize your role and play that position well.
Be prepared
Your time may come to shine and show what you can do. Sometimes being in and out of operating rooms saying nothing and feeling like a shadow can create a sense of complacency. We don't say much and they don't say much to us, so we may feel free of responsibility. However, for every patient you observe, there is an implicit expectation you understand what surgery is being done, why it is being done, and on whom it is being done. I had just came from morning report and observed a procedure in the operating room and after it concluded the surgeon turns to me and asks "What did the patient have?" I didn't read anything about the patient or the surgery before, so I made an educated guess based the fluoroscopic imaging we just did and said what I thought it looked like. I was wrong and the surgeon told me to read up on these topics. In another case, it was my first time working with a different surgeon and I immediately got the vibe this was a no-nonsense person who likes things done the proper way. I stayed silent the whole time. At the end of that surgery, the surgeon turns to me and tells me I am going to close one of the incisions. My very first attempt at tying a suture on a real human failed miserably and the surgeon took over and finished the knot. The surgeon told me I need to practice tying knots at home with gloves on so I can actually tie properly on real humans.
Be adaptable
Different people operate differently. Some surgeons are happy for you to be proactive, whereas other surgeons will be more cautious and if they see you trying to be proactive, they will shut you down and tell you to keep your hands away from the instruments. It's weird. It's jarring. You have to recognize the real world doesn't follow rigid unchanging rules. This is the nature of people to have their idiosyncrasies. The sooner you take feedback in stride and learn quickly, the sooner you can be on your way to success.