1. Clinical Experience Operative Case Summary: Enter Name of Procedure
ST310/ST320
Concorde Career College, Enter Campus
Student Name: Enter Name
Date: Enter Due Date
Surgeon: Enter Name
Preceptor: Enter Name

2. Name of Procedure
Choose the most challenging procedure scrubbed since the previous Clinical Conference, or first day of the term if First Clinical Conference.
Receive an assigned procedure from the instructor if no cases scrubbed

3. Definition of Procedure
Include a detailed definition of the procedure

4. Indications for Surgery
List the specific indications (signs & symptoms, diagnostic results, preoperative diagnosis) that led to this surgical intervention
These must be specific to the patient and not hypothetical

5. Anesthesia Type
What type of anesthesia was used (route of administration, agents, etc.)?
Why was this chosen?

6. Skin Prep
Provide a detailed diagram of the skin prep perimeters used on this patient

7. Surgical Incision Provide a detailed diagram of the incision site
Label the anatomy within the incision
What was this incision/approach chosen?
May need to hand draw

8. Patient Position List the specific position used
List all supplies and equipment used
Why was this position chosen?

9. Draping List all materials and the sequence of application
Where there any special considerations made?

10. Equipment
List all equipment used and state why each was necessary

11. Instrumentation List all basic and specialty instrumentation
Provide images and descriptions of three particular instruments used in this procedure
Preferably items that were unfamiliar

12. Supplies List all supplies needed and utilized
Use physician preference card as resource

13. Pharmacology
List ALL agents used and state their specific purpose during this procedure

14. Mayo Setup
Outline and diagram the specific Mayo stand setup used to facilitate this procedure
List reasons why this setup was useful
How can the setup be improved?

15. Sutures List all suture used on this procedure
List the physical characteristics for each
What types of suture needles were used?
In which tissues/wound layers was each suture used?
What was the surgeon’s rational for specific suture choice?

16. Operative Procedural Steps
Provide a detailed account of each step of the procedure
This section should mirror the surgeon’s operative report in style and content.
Highlight specific anatomy and physiology and provide detailed diagrams

17. Drains & Dressing List any drains used and state the purpose of each
List all dressing materials used
Outline the procedure used to dress this wound

18. Specimens & Implants List all surgical specimens
List all materials implanted into the wound

19. Postoperative Diagnosis
State the diagnosis
Did this change from the preoperative diagnosis? If so, why?

20. Possible Complications
List all specific possible complications that may result from this procedure
Be specific

21. Prognosis How is the patient expected to recover?
What is the wound class?
Are there any long-term effects to consider?
Will another operation be needed?

22. Most Important Knowledge Learned
What was the most interesting or valuable thing that you learned while scrubbing this procedure?
How will this information help you in the field?
Looking back, would you have done anything differently?

23. REFERENCES
Insert references here