Surgical technologist

A surgical technologist, also called "scrub tech," "surgical technician," or "operating room technician", is an allied health professional working as a part of the team delivering surgical care in some countries. They possess knowledge and skills in sterile and aseptic techniques. There are few mandatory professional requirements for surgical technologists, and the scope of practice varies widely across countries and jurisdictions. Surgical technologist attend junior colleges and technical schools, and many are trained in military training schools. In the military they perform the duties of both the circulator and the scrub. The bulk of training is done in the operating room, and they are trained by giving them progressively more difficult surgical cases to scrub, until they are able to scrub all types of surgical procedures, this can take a few years. The goal is for surgical technologist to be able to anticipate the next move the surgeon is going to make in order to make the procedure as smooth and efficient as possible.

In the United States, surgical technologists are unlicensed assistive personnel who work under the supervision of a surgeon, registered nurse (RN), or other surgical personnel (such as a more senior Technologists), to help ensure that the operating room or environment is safe, that equipment functions properly, and that the operative procedure is conducted under conditions that maximize patient safety. They handle the instruments, scrubs, medications, and other supplies and equipment necessary during the surgical procedure. They perform basic tasks such as checking patients' medical charts and consent forms, preparing sterile dressings, and closing incisions. Surgical Technologists also train other OR personnel such as new technologists and new circulating RNs.^[1]

In Mozambique, they provide advanced surgical services, often working autonomously in the absence of a physician.^[2] In other countries, professions with similar titles include 'Clinical officers', 'Clinical associates', or 'Assistant Medical Officers', but which can mean different things subject to local circumstances.

Employment

Most surgical technologists — about 71 percent in the United States — work in hospitals, mainly in operating and delivery rooms. Surgical technologist are also adaptive to deal with equipment handling, as handling a C-arm flouroscope in angioplasty and orthopedics and in many other departments as well. A surgical technologist with multiple experiences is preferred. Other jobs are in offices of physicians or dentists who perform outpatient surgery and in outpatient care centers, including ambulatory surgery centers.^[1] In the US, depending on the role and employment setting, they may go by different titles including Scrub Surgical Technologist, Circulating Surgical Technologist or Second Assisting Technologist.^[3][4] A few technologists in private practice (also called 'private scrubs') are employed directly by surgeons who have special surgical teams, like those for liver transplants.

Career prospects for surgical technologists is expected to grow in the coming years. According to the US Bureau for Labor Statistics, employment of surgical technologists is expected to grow in that country by 24 percent between 2006 and 2016, much faster than the average for all occupations.^[1] This trend is related to the expected rise in the number of surgical procedures performed, as the population grows and ages. Older people, including the baby boom generation, who generally require more surgical procedures, will account for a larger portion of the general population. In addition, technological advances, such as fiber optics and laser technology, will permit an increasing number of new surgical procedures to be performed and also will allow surgical technologists to assist with a greater number of procedures.^[1]

History

United States

The role of the Surgical Technologist began on the battlefields in World War I and World War II when the Army used "medics" to work under the direct supervision of the surgeon. Concurrently, medical "corpsman" were used in the Navy aboard combat ships. Nurses were not allowed on the battlefield or aboard combat ships at the time. This led to a new profession within the military called operating room technicians (ORTs).

With many medical personnel overseas or performing duties in military hospitals, an accelerated nursing program with emphasis only on operating room technology was set up as an on-the-job training of nursing assistants who worked in the surgery department. These individuals studied sterilization of instruments and how to care for the patient in the operating room. Techniques, sutures, draping and instrumentation were emphasized; they also had to do clinical time in labor and delivery and the emergency room.

After the Korean War there were shortages of operating room nurses. Operating room supervisors began to recruit ex-medics and ex-corpsmen to work in civilian hospitals. These ex-military men functioned as circulators in the operating room while the scrub role or "instrument nurse" role was performed by the registered nurse. It wasn't until 1965 that these roles were reversed.

In 1967, the Association of periOperative Registered Nurses (AORN) published a book titled Teaching the Operating Room Technician. In 1968, the AORN Board of Directors created the Association of Operation Room Technicians (AORT). The AORT formed two committees in 1969, The Liaison Council on Certification for the Surgical Technologist or LCC-ST (now known as the National Board of Surgical Technology and Surgical Assisting or NBSTSA^[5]) and the Joint Committee on Education. The first certification examination was given in 1970, and those that passed the certification examination were given a new title: Certified Operating Room Technician (CORT).

In 1973, AORT became independent of AORN and changed the title of the position to what it is today, Surgical Technologist. The AORT also changed their name to the Association of Surgical Technologists (AST).^[4] In 1974, an accreditation body was established to ensure quality education. The programs accredited by ARC/STSA (Accreditation Review Committee for Surgical Technology and Surgical Assisting) (formerly ARC-ST) are monitored for compliance with the standards. The ARC/STSA and AST board of directors recommends the associates degree as entry level surgical technology education.

Today, surgical technologists taking and passing the national certification examination designed by the NBSTSA earn the title of "Certified Surgical Technologist". Certification can be renewed by contact hours or re-examination. Laws for surgical technologists vary by state and many states are in various stages of legislation. Some require certification, some require state registration, some require state licensure, and some have no laws at all.

Mozambique

Surgical technologists were introduced around 1984 in the aftermath of a long civil war that had crippled the health sector.

They are trained to provide comprehensive medical and surgical care, filling a gap created by the shortage of surgeons, especially in rural areas.

They do obstetric and emergency surgery and traumatology and are also the administrators at district-level hospitals.^[2]

It is estimated that surgical technologists perform 90 percent of all obstetric surgeries in the country.^[6]

Training, certification and professional organizations

United States

Educationally, surgical technologists graduate from surgical technology programs accredited through the Commission on Accreditation of Allied Health Education Programs (CAAHEP),^[7] which relies on information on a program gathered by a collaborative effort of the Association of Surgical Technologists (AST)^[4] and the American College of Surgeons (ACS). The CAAHEP is a recognized accreditation agency of the Council for Higher Education Accreditation (CHEA).^[8] In addition, surgical technology programs are located in educational institutions that are institutionally accredited by agencies recognized by the United States Department of Education (USDE) or The Joint Commission. The ARC/STSA is also a member of the Association of Specialized and Professional Accreditors (ASPA).

The following statement was developed by the American College of Surgeons’ Committee on Perioperative Care, and approved by the ACS Board of Regents at its June 2005 meeting.^[9] This statement was subsequently approved by the Association of Surgical Technologists, American Society of Anesthesiologists, American Association of Surgical Physician Assistants, American Association of Nurse Anesthetists, and American Society of PeriAnesthesia Nurses.

Surgical technologists are individuals with specialized education who function as members of the surgical team in the role of scrub person. With additional education and training, some surgical technologists function in the role of surgical first assistant. Surgical technology programs are inspected by the Accreditation Review Committee on Education in Surgical Technology—a collaborative effort of the Association of Surgical Technologists and the American College of Surgeons, under the auspices of the Commission on Accreditation of Allied Health Education Programs. Accredited programs provide both didactic education and supervised clinical experience based on a core curriculum for surgical technology. Accredited programs may be offered in community and junior colleges, vocational and technical schools, the military, universities, and structured hospital programs in surgical technology. The accredited programs vary from nine to 15 months for a diploma or certificate to two years for an associates degree, which is the preferred entry level. Graduates of accredited surgical technology programs are eligible for certification by the National Board of Surgical Technology and Surgical Assisting (NBSTSA), an administratively independent body from the Association of Surgical Technologists consisting of representative Certified Surgical Technologists, a surgeon, and the public. The American College of Surgeons strongly supports adequate education and training of all surgical technologists, supports the accreditation of all surgical technology educational programs, and supports examination for certification of all graduates of accredited surgical technology educational programs.

The professional organization for surgical technologists is the Association of Surgical Technologists (AST).^[4] Its primary purpose is to ensure that surgical technologists have the knowledge and skills to administer quality patient care and is the principal provider in conjunction with more than 40 state organizations of continuing education for surgical technologists.

Mozambique

In Mozambique, surgical technologists first qualify as clinical officers then, after working for at least three years, they complete another three-year program that focuses on obstetrics, traumatology and emergency medicine.

The first two years involve supervised surgical training under senior surgeons at Maputo Central Hospital followed by an internship year at a provincial hospital.^[10]

Surgical technologists perform routine and emergency surgery autonomously, often working in hospitals that do not have surgically qualified physicians.

See also

• Allied health professions
• Clinical associates
• Assistant Medical Officer

References

1. ^ ^{a b c d} US Bureau of Labor Statistics. Occupational Outlook Handbook, 2010-11 Edition - Surgical Technologists. Accessed 5-Mar-2011.
2. ^ ^{a b} Cumbi A et al. "Major surgery delegation to mid-level health practitioners in Mozambique: health professionals' perceptions." Human Resources for Health; 2007, 5:27 doi:10.1186/1478-4491-5-27
3. ^ American College of Surgeons
4. ^ ^{a b c d} Association of Surgical Technologists. Accessed 5-Mar-2011.
5. ^ National Board of Surgical Technology and Surgical Assisting
6. ^ Kruk ME et al. "Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey." PLoS Medicine, 2010; 7(3): e1000242. doi:10.1371/journal.pmed.1000242
7. ^ Commission on Accreditation of Allied Health Education Programs
8. ^ Council for Higher Education Accreditation (CHEA)
9. ^ American College of Surgeons. Revised Statement on surgical technology training and certification. Accessed 6 April 2011.
10. ^ World Health Organization. The world health report 2003: shaping the future. Geneva, WHO, 2003 http://www.who.int/whr/2003/en/index.html

External links

• Accreditation Review Council on Education in Surgical Technology and Surgical Assisting
• American College of Surgeons
• Association of Surgical Technologists
• Commission on Accreditation of Allied Health Education Programs
• Council for Higher Education Accreditation
• Mayo Clinic School for Health Science
• National Board of Surgical Technology and Surgical Assisting
• U.S. Bureau for Labor Statistics