Case Library

Pick a surgeon and a surgery to study the full card: setup, draping order, instruments, case flow, and that surgeon's quirks — then drill it until it's automatic. Studying as — your proficiency is tracked per case.

Specialty

Missing a case or a surgeon? Anyone can add or update cards in the Edit Library tab.

Getting started

Five things that get the app working for you. Each one ticks itself off from your actual activity — there's nothing to mark complete by hand.

My Progress

Built from what you've actually done — case levels you've set, drills you've run clean, cards you've rated, and Test Prep questions you've answered.

What to do next

Picked from wherever you're weakest right now.

Install FirstCase on your phone

It installs from the browser — there's no App Store or Play Store download. You get a real home-screen icon, it opens full screen with no browser bars, and the study material works with no signal.

iPhone / iPad (Safari)

Safari has no automatic install prompt — Apple only allows the manual route:

  1. Open this site in Safari (Chrome on iPhone can't install it).
  2. Tap the Share button — the square with an arrow pointing up.
  3. Scroll down and tap Add to Home Screen.
  4. Tap Add. The glove icon appears on your home screen.

Android (Chrome)

  1. Tap 📲 Install app under your name at the top right, if it's showing.
  2. Otherwise tap Chrome's ⋮ menu and choose Install app or Add to Home screen.

Computer (Chrome / Edge)

Look for the small install icon at the right-hand end of the address bar, or use the ⋮ menu → Cast, save and share → Install page as app.

Send feedback

Found a bug, spotted something wrong in a case card, or have an idea? Send it straight to the program lead. Include what you were doing when it happened.

Start here

How to actually retain this job

Struggling to retain isn't a knowledge problem — it's usually a framework problem. Memorizing 40 setups item-by-item is impossible. Learning why each item exists makes every case a variation of one pattern.

The one mental model

Every surgical case, from a carpal tunnel to a CABG, has the same skeleton:

  1. Get in — incise, control bleeding, retract (knife, Bovie, clamps, retractors)
  2. Do the work — the procedure-specific part (the implants, the fusion, the grafts, the repair)
  3. Get out — irrigate, verify counts, close in layers, dress

When you learn a new case, don't memorize the card — ask: what does the surgeon need to get in, do the work, and get out? The card becomes a checklist, not a mystery.

The daily 10-minute routine (this is where retention comes from)

  • Before each case (3 min): open its card in the Case Library, then close your eyes and mentally rehearse the first 5 things that will happen after the drape goes up.
  • After each case (3 min): write down ONE thing you didn't anticipate and one thing that went well. A pocket notebook beats any app.
  • End of day (4 min): run 10 flashcards and one drill in this app. Spaced, small reps beat cramming every time.
Why this works: retrieval practice (quizzing yourself) and spaced repetition are the two most proven learning techniques there are. Re-reading a preference card 10 times does almost nothing; recalling it from memory once does a lot.
Module 1 — Case setup, start to finish

Before you scrub

  1. Read the preference card — procedure, surgeon, position, instruments, sutures, meds, special equipment.
  2. Verify the case cart against the card. Pull missing items NOW, not after you're sterile.
  3. Check the room: bed orientation, tourniquet, C-arm/imaging, positioning devices, implant trays present, suction and Bovie functional.
  4. Inspect every package: integrity (no holes, no moisture, no broken seals), external chemical indicator changed, within expiration where applicable. If in doubt, it's out.
  5. Open in order: back table pack first → basin set → instrument trays → wrapped smalls → peel packs. Open away from your body first, toward you last. Peel packs get flipped or presented — never dumped from arm's length across the field.

Once you're sterile

  1. Scrub → dry with sterile towel → gown → closed glove → turn with circulator.
  2. Drape the mayo stand (hands protected inside the cuff of the mayo cover).
  3. Organize the back table the SAME way every single case (see Module 2).
  4. Check internal indicators in every tray as you organize. Assemble, inspect, and test instruments (scissors cut, ratchets hold, screws present).
  5. Initial counts with the circulator: sponges → sharps → instruments, per policy, out loud, both people seeing each item.
  6. Receive and label every medication and solution on the field immediately — drug, strength, date if required. An unlabeled cup gets discarded.
  7. Dress the mayo with the first-phase instruments ("get in" items), load the blade(s) with a needle driver — never fingers.
Time target: a seasoned tech aims to be counted, labeled, and mayo-ready before the patient is asleep. Early on, your goal is simply no wasted motion — touch each item once, put it where it lives.
Module 2 — Back table & mayo organization
The rule that makes you fast: same layout, every case, forever. Speed doesn't come from moving fast — it comes from your hands knowing where everything is without looking.

Back table zones (one proven layout)

ZoneWhat lives there
Front edge (working row)Items you'll hand off next: sponges, ties, next instruments up
Left blockInstrument trays / stringers, in order of use, ring handles toward you
Right blockDrapes (in reverse order of use — first drape used on top), gowns, towels
Back rowExtras and later-phase items: closing tray, dressings, spare sponges
Sharps zoneONE designated corner: blades, needles, magnetic mat / needle counter. Sharps never wander.
Meds zoneLabeled cups/basins together, syringes labeled, local separate from irrigation

Mayo stand = the next 10 minutes of the case

  • Only what's needed for the current phase. Rotate items back to the table as phases finish.
  • Typical opening mayo: knife (or blade + handle staged), Bovie, pickups (Adsons + DeBakeys), scissors (Metz + Mayo), hemostats, retractors for the approach, sponges.
  • Handles toward the field, tips toward you. Curves all facing the same way. It should look the same in every photo.
Ortho-specific: keep power equipment (drill/saw) assembled, tested, and on the back table until needed — safety on, no attachments dangling. Implants and trials stay in their caddies until the rep/surgeon calls sizes; repeat every size back verbatim.
Module 3 — Draping: principles first, then orders

The 8 rules that never change

  1. Drape from the incision site outward to the periphery.
  2. Handle drapes as little as possible; don't shake, fan, or flip them.
  3. Hold drapes above waist level, compact, until placed.
  4. Cuff your gloved hands inside the drape edge when placing near unsterile areas (the patient is not sterile — the prepped skin is "surgically clean," not sterile).
  5. Once a drape is placed, it is never moved or shifted. Wrong spot? It stays or the circulator peels it away — you place a fresh one.
  6. Never reach across an undraped (unsterile) area — drape the near side first, walk around for the far side if needed.
  7. Anything below table level or out of sight is unsterile.
  8. Perforating towel clips that go through a drape don't come back — tips are contaminated; if removed, discard from field and cover the site.
Where are the draping orders? Each surgeon's exact sequence lives on their case cards in the Case Library — with a tap-in-order drill generated automatically from it. These 8 principles are what never change from card to card.
Module 4 — Passing instruments correctly

Universal passing rules

  • Pass decisively, with a firm, deliberate snap into the palm — the surgeon should never have to look away from the field or reposition the instrument.
  • Ring-handled instruments: handle to palm, closed to the first ratchet, tips visible and pointing up/away from the hand.
  • Curved instruments: curve aligned with the natural curve of the surgeon's hand — tips curving in the direction of use.
  • Know your surgeon's handedness and pass to the operating hand at working height, over the field — never over the wound unless that's where it's going.

Specific instruments

ItemHow to pass
ScalpelNeutral zone (hands-free) is the standard where used: place in a basin/mat, announce "knife down." If hand-passing per surgeon: pencil-grip the handle, blade down and away from both palms.
Loaded needle driverNeedle clamped about one-third from the swaged (suture) end, point up, curve ready for the operating hand — no repositioning needed. Control the trailing suture with your other hand so it doesn't drag.
Scissors / clampsRing handles into palm, first ratchet closed, curve matching the hand.
Pickups (forceps)Vertical, tips down, into a pencil grip.
RetractorsHandle first; for hand-helds, offer so the blade faces the wound side it will retract.
Power (drill/saw)Safety on, correct attachment locked and tested, pass grip-first, foot pedal / trigger clear. State the attachment: "drill with the 3.2."
Mallet + implant/tampTamp/impactor to the operating hand first, mallet to the other; keep your hands out of the swing path.
Confidence hack: a slow, correct, firm pass reads as more competent than a fast fumbled one — and firm passes are what surgeons actually register as "this tech knows what they're doing." Slow is smooth; smooth is fast.
Module 5 — Anticipation: staying one step ahead

Anticipation is the difference between a tech who hands what's asked and a tech who runs the case. It's a learnable skill with three inputs:

1. Watch the field, not your table

  • Bleeder appears → hemostat/Bovie up before it's asked.
  • Surgeon's hand opens flat toward you → the last instrument's partner is coming (clamp→tie, knife→pickup with sponge).
  • Irrigation called → closure is coming: start staging counts, sutures, dressings mentally.

2. Know the phase pairs (things that always travel together)

When this happens……have this ready
Knife passed for incisionSponge + pickups, then Bovie
Clamp placed on a bleederTie or Bovie touch, then suture scissors
Suture passedPickups for the surgeon, scissors ready for you or the assist
Self-retaining retractor inDeeper phase begins — swap mayo to next-phase instruments
Trial implant acceptedReal implant confirmed with rep, implant instruments up
"Irrigation"Closing count prep, first closure suture loaded

3. Rehearse the script

Before each case, open its card in the Case Library and say the first ten moves out loud or in your head. Ten mental reps make one real rep feel familiar.

When you don't know what's next: ask ONE good question at the right moment — "Doctor, ties or clips for these?" during a lull beats guessing wrong. Surgeons trust techs who ask smart questions early far more than techs who freeze.
Module 6 — Counts & when things go wrong

Count timing (typical policy)

  1. Initial — before incision (baseline).
  2. First closing — at closure of a cavity or deep layer.
  3. Final — at skin closure.
  4. Plus: any time a new item is added to the field (count it in, out loud) and at staff relief.

Emergency scripts — decide NOW so you don't freeze later

EventYour move
You contaminate a glove/sleeveSay it immediately — "I contaminated, need a re-glove." Step back, circulator pulls the glove, re-glove (or re-gown). Nobody good ever got fired for calling their own contamination; techs DO lose trust for hiding it.
Instrument drops below table levelIt's gone. Announce it, kick it clear or have the circulator retrieve it, get the backup. Never re-use it.
Count is offTell the surgeon immediately, recount, search field → drapes → floor → trash. Not resolved → X-ray per policy. Never sign a count you didn't verify.
Hole/strike-through in a drapeCover with an impervious barrier or re-drape per policy; moisture strike-through = contaminated.
You're asked for something you don't recognize"Show me one time and I've got it from there." Then write it in your notebook post-case.

Drills

Tap the steps in the correct order. Wrong taps shake and count against you. Universal drills below — case-specific draping and case-flow drills launch from each card in the Case Library.

Scenario Quiz

Real intraoperative situations, plus anything you or a classmate has added.

Pick your move, read the why. Questions shuffle each round.

CST / NBSTSA exam prep

Test Prep

Board-style multiple choice — anatomy, microbiology, asepsis, pharmacology, procedures, terminology.

Source, domain & quantity
Domain filter (Practice mode only — Exam and Missed-questions always use the full pool)
How many questions (Practice/Exam — Missed-questions always uses everything you've missed)

Instrument Flashcards

Tap the card to flip. Say the answer OUT LOUD before flipping — retrieval is the whole point.

tap to flip

Competency Checklists — 8-Week Preceptor Program

Print this tab (Ctrl+P) and keep one packet per trainee. Each item is signed off when performed independently, without prompting, on a real case. "Observed once" ≠ competent — sign only what you'd bet a case on.

FirstCase Academy

Competency Checklists — 8-Week Preceptor Program

Preceptor Guide — how to teach so it sticks

The scaffold ladder (never skip rungs)

  1. I do, you watch — trainee observes and narrates back what they saw afterward.
  2. I do, you assist — trainee handles one defined slice (e.g., just the mayo, just counts).
  3. You do, I assist — trainee runs it; you fill gaps silently and note them for the debrief.
  4. You do, I watch — trainee runs it solo with you scrubbed but hands-off, then unscrubbed in the room.

Move up a rung when the trainee performs the current one without prompting twice in a row. Move DOWN a rung after a rough case without shame — the ladder goes both ways and that's normal.

Brief → Do → Debrief (every case, 5 minutes total)

  • Brief (2 min, before scrubbing): "What's today's ONE focus skill? Talk me through the first five moves after draping." Have them open the case card in the library the night before.
  • Do: trainee owns the focus skill. Resist grabbing — a 10-second fumble they solve is worth more than a smooth case you did for them. Intervene for safety only.
  • Debrief (3 min, same day): three questions, always the same:
    1. What went well?
    2. What would you do differently?
    3. What's our target next case?
    Trainee answers first, then you. Write the target on the checklist packet.

Rules that protect confidence

  • One focus skill per case. Correcting everything at once teaches nothing and rattles them.
  • Correct in private, praise in the room. Surgeon-audible criticism sets training back weeks.
  • Normalize the call-out. Openly praise self-reported contamination/mistakes — the behavior you reward in week 2 is the behavior you get in year 5.
  • Separate speed from sequence. Weeks 1–4, only sequence matters. Speed is banned as a topic until the sequence is automatic — it shows up on its own.
  • Name the win. "You had the Bovie up before he asked — that's anticipation" builds skill-awareness faster than generic "good job."

Suggested weekly rhythm

WeeksPhase focusLadder rung
1–2Foundations: room setup, opening, back table, counts, sterile conscience1 → 2
3–4Draping + case starts: square-offs, first-phase mayo, first case cards2 → 3
5–6Passing + anticipation: running the mayo through whole cases3
7–8Independence: solo cases with preceptor as backup; emergency scripts verbalized3 → 4

After week 8, the Case Library becomes the career-long track: each new surgeon/procedure card a tech takes from "Reviewed" to "Solo-ready" widens what they can safely be scheduled for. The progress board (Edit Library tab, trainers only) shows the whole team at a glance.

Edit the case library

Surgeons

Add surgeon

Before adding, check the list above — if the surgeon exists, edit their entry instead. Exact duplicates are blocked automatically.

My Notes

A private scratchpad — facilities, staff, surgeons, cases, your own preferences (glove size, whatever helps). Only you can see these — not even trainers.

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