When “That’s Just How We Do It” Becomes Dangerous

Preparing the Next Generation of Surgical Technologists to Learn, Adapt, and Speak Up

By Professor N. Dimitri Brown, CST | The Scrub Professor

Welcome to The Scrub Professor.

For my first post, I wanted to begin with something that sits at the center of how I approach Surgical Technology education:

Knowing how to perform a task is not enough.

A Surgical Technologist also needs to understand why it is being done, recognize when something is not right, adapt as surgical care evolves, and have the confidence to speak up when patient safety is involved.

That responsibility begins long before someone earns the letters CST after their name.

It begins in the classroom.

It begins in the lab.

It begins in clinical.

And it begins with teaching students that their knowledge and their voice both matter.

The Operating Room Has a Hierarchy — Patient Safety Does Not

The operating room is naturally built around defined roles. There is a surgeon, an anesthesia provider, a circulating nurse, a surgical technologist, and often residents, students, and other members of the surgical team.

Each person has different responsibilities.

But there is one responsibility they all share: Protecting the patient.

Problems arise when hierarchy becomes more powerful than a team member's willingness to question, think critically, or raise concerns.

Paul and Elder (2019) describe sociocentric thinking as accepting a group's assumptions or beliefs without sufficiently questioning them.

In the operating room, that can sound like:

“This surgeon always does it this way.”

“Nobody else said anything.”

“I’m only the student.”

“They have more experience than I do.”

“I’m sure somebody else already noticed.”

Most people working in healthcare will eventually experience a moment when it feels easier to go along with everyone else than to ask the uncomfortable question.

In the operating room, however, silence is not always harmless.

Research examining the willingness of OR team members to challenge authority has identified hierarchy, organizational culture, and education as factors influencing whether individuals feel comfortable speaking up (Pattni et al., 2019). The World Health

The organization has similarly identified asteep hierarchy as a potential barrier to effective teamwork and communication.

When a patient's condition can change within seconds, communication matters.

So does confidence.

The OR Our Students Enter Tomorrow Will Not Be the OR We Know Today

Surgical Technology has never been a profession where someone can learn a list of instruments, memorize the steps of a procedure, pass an examination, and stop learning.

Healthcare technology is moving too quickly for that.

Today's operating rooms include increasingly sophisticated:

• Robotic surgical platforms

• Navigation systems

• Advanced energy devices

• Minimally invasive technology

• Surgical imaging

• Implant systems

• Specialized instrumentation

• Electronic documentation systems

• Artificial intelligence

• Data-driven surgical technology

And that list will continue to grow.

The equipment a Surgical Technology student learns to use in school may not be the equipment they use five or ten years into their career.

That means our responsibility as educators must go beyond teaching students which instrument to pass or which button to push.

We have to teach students how to learn.

A strong Surgical Technologist should be able to encounter something unfamiliar and think:

What is this?

What does it do?

How does it affect the procedure?

What are the safety considerations?

How does this fit with what I already know?

That ability to adapt will become increasingly important as technology continues to reshape the surgical environment.

The future CST cannot simply be technically competent.

The future CST must be a lifelong learner.

Technical Knowledge Alone Does Not

Make an OR Safe

Someone can be technically skilled and still hesitate when it matters most.

A person may recognize that something is wrong and remain silent out of fear, deference to hierarchy, uncertainty, or concern about how the rest of the team will react.

This is where group thinking can become a genuine patient-safety issue rather than merely an academic concept.

And it is not always obvious when it is happening.

Sometimes, everyone else appears comfortable.

Nobody reacts.

A senior team member dismisses a concern.

The case continues.

Eventually, people can begin accepting something simply because:

“That’s just how we do it.”

That sentence should make every healthcare professional stop and think.

It's TOXIC!

Because how we have always done something and the safest way to do something are not automatically the same thing.

Medicine changes.

Technology changes.

Evidence changes.

Standards change.

Our practice has to be willing to change, too.

Are We Teaching Judgment — or Compliance?

Surgical Technology students obviously need technical knowledge.

They need instrumentation.

• Sterile technique.

• Anatomy.

• Microbiology.

• Pharmacology.

• Positioning.

• Surgical procedures.

• Equipment.

• Patient care.

But while they are learning all of those things, they are also learning something that may never appear on a written examination.

They are learning the culture of the operating room.

Students notice everything.

They notice how experienced team members respond when someone asks a question.

They notice whether concerns are welcomed or dismissed.

They notice how people communicate with one another.

They notice who seems comfortable speaking.

And they notice who stays quiet.

If we teach students that experience, seniority, or job title should never be questioned, we risk teaching compliance instead of professional judgment. That directly undermines the patient-advocacy role we expect Surgical Technologists to develop.

I want students to understand something very early in their education:

Respecting someone's experience does not require abandoning your own judgment.

You can respect a surgeon and still ask a question.

You can respect your preceptor and still identify contamination.

You can be a student and still recognize an unsafe situation.

You can be nervous and still speak.

Study Hard Enough to Understand the “Why”

This is one of the reasons I believe Surgical Technology students should take studying seriously.

Not because a grade determines your worth.

Not because you have to know everything.

And certainly not because Surgical Technology education should become an exercise in memorizing information long enough to survive the next test.

You study because knowledge creates options.

Knowledge helps you anticipate.

Knowledge helps you recognize.

Knowledge helps you question.

And knowledge helps you communicate.

• When you understand anatomy, you begin anticipating where the surgeon is going.

• When you understand instrumentation, you can predict what may be needed next.

• When you understand microbiology and sterile technique, you understand why contamination matters.

• When you understand pharmacology, you are better prepared to recognize something unusual about a medication or solution.

• When you understand a surgical procedure rather than simply memorizing its steps, you can recognize when the procedure is no longer following the expected course.

That knowledge becomes especially important when you need to say:

• “I have a concern.”

• “That was contaminated.”

• “Can we verify this?”

• “Something doesn't look right.”

Those statements become easier to make when you have put in the work to understand what you are seeing.

So yes:

Study hard.

Not simply to pass the CST exam.

Study so that one day, when a patient is depending on the surgical team, you have enough knowledge to recognize when something deserves a second look.

Speaking Up Is a Clinical Skill

Confidence is not something every student walks into Surgical Technology school already possessing.

That's okay.

Confidence can be developed.

So can communication.

So can critical thinking.

So can the ability to speak up.

We practice:

• gowning.

• gloving.

• counts.

• instrumentation.

• room setup.

• simulate procedures.

We should also practice saying:

“I need to stop for a second. I have a concern.”

Simulation, briefings, time-outs, case discussions, and debriefings can all help establish a culture in which communication is expected before students encounter a critical situation involving an actual patient. Structured communication and leadership support are important parts of creating an environment where team members feel able to raise concerns.

Speaking up should not be treated as disrespect.

When done professionally and appropriately, speaking up is part of patient advocacy.

And patient advocacy is the responsibility of every member of the surgical team.

Preparing the Next Generation of CSTs

My vision for The Scrub Professor is bigger than helping students pass the CST exam.

Do I want you to pass?

Absolutely.

I want you to know your instruments.

I want you to understand surgical procedures.

I want you to be prepared for clinical.

I want you to walk into the operating room confidently.

And I want CST behind your name.

But certification should represent the beginning of your professional development—not the end of it.

I want to help prepare a generation of Surgical Technologists who can walk into an operating room that may look completely different from the one in which they originally trained and still know how to think, learn, adapt, and advocate.

Technology will change.

Instrumentation will change.

Surgical techniques will change.

Equipment will change.

The profession will continue to evolve.

Our education must evolve with it.

The principles underlying excellent surgical care, however, remain essential:

Preparation.

Knowledge.

Critical thinking.

Surgical conscience.

Teamwork.

Communication.

Patient advocacy.

Those are the qualities I want The Scrub Professor to help develop.

My professional interests include workforce readiness, educational innovation, AI-supported learning, organizational performance, and improving the ways we prepare future Surgical Technologists for an increasingly complex healthcare environment.

This platform will be a place where we can ask questions, challenge ourselves, review the fundamentals, explore new technology, prepare for certification, and talk about what happens when textbook knowledge meets the reality of the operating room.

Most importantly, I want every student who finds this platform to remember:

Do not be afraid to study hard.

Do not be afraid to admit what you don't know.

Do not be afraid to ask why.

And when patient safety is involved, do not be afraid to speak up.

Critical thinking is not simply knowing the right answer.

Sometimes it means having the courage to question the answer everyone else has already accepted.

Welcome to

The Scrub Professor!

👑

Study smarter. Think critically. Speak confidently.

Educate. Elevate. Operate.

References

Pattni, N., Arzola, C., Malavade, A., Varmani, S., Krimus, L., & Friedman, Z. (2019). Challenging authority and speaking up in the operating room environment: A narrative synthesis. British Journal of Anaesthesia, 122(2), 233–244.

Paul, R., & Elder, L. (2019). The miniature guide to critical thinking concepts and tools (8th ed.). Foundation for Critical Thinking.

World Health Organization. (2009). WHO guidelines for safe surgery 2009: Safe surgery saves lives.