General knowledge of the procedure
Mohs work flow (inc. efficiency)
Mohs appropriate criteria
Understanding how to explain to patients what Mohs is and its benefits
Surgical/sterilization methods
Type of sutures
Taking proper medical history
Understanding each type of skin cancer and how they grow
Patients education
Hand placement
Post-operative wound care instructions (specific to type of defect/repair type/location)
Patient positioning to save time for the Mohs surgeon during staging
Making sure the patient has had adequate numbing prior to staging
Using patient identifiers prior to rooming patients
Getting all information for H&P
Recording medications for new patients and checking the status of established patients’ medication lists (new meds, any changes)
Understanding how wounds heal by second intention
Communicating with the patient during staging (asking about their comfort level)
Assistants establishing a solid routine so they do not forget important steps
Establishing a routine for pre-op, so steps are not forgotten (inc. questions regarding health history, health status, medications)
Staying calm and focused during the surgery
Being mindful of what you say out loud
Conveying confidence to the pt
Keeping patients trays separate (knowing what patient tray belongs to what patient)
Knowing how to properly set up room for surgery
Properly documenting
Tray setup
Staple/suture removal
How to discuss aftercare with patients based on the different types of closures (i.e., bi-lobe vs. flap vs. graft)
Types of suturing styles (i.e., horizontal mattress vs. purse string vs. interrupted vs. purse string, etc.)
Knowing the correct medical/surgical terminology
Proper technique of washing and packing instruments
Understanding the procedure
Specimen handling
Being able to explain procedure appropriately
Pre-op size, post-op size, and final closure length
Making sure to photograph all the steps
Actually understanding how the procedure works and why it's done the way it is
Understanding proper scheduling (giving appropriate time for larger cases, how to handle coordinated closures etc.)
Importance of completely wiping down beds, pillows, hyfrecators, counters etc after each patient
Quality control (i.e., making sure info on maps is correct)
Understanding the difference between clean technique and sterile technique (and how to maintain)
Appropriate bandaging for each repair type – inc. ability to bandage unusual areas (i.e., pressure on ear, near eyes, etc.)
Knowledge of surgery protocol
The significance of not disturbing the open site while processing of the tissue
Proper specimen handling
Learning how to adapt to the preferences of the different doctors in the clinic
Overview of repairs and repair types
Knowing surgical instrument names and purpose
Always remembering to wash their hands
Taking preop, post-op and final repair photographs
Cleaning of room between layers of cases so MD can quickly move to next case. Sometimes the clean-up takes longer than retrieving tissue sample
Any and all regulatory/safety items, safety, orientation, maintenance regulations, etc
Operation of EMR, accurate completion of notes
Discharge instructions
Efficiency in getting the patient prepped for the surgeon
Getting the patient ready for the surgeon, including identification of surgery location with patient
Flaying the specimen to get the skin edge down
How to properly screen/accept patients being referred for Mohs
Understanding how to administer local anesthesia adequately for surgery on different areas of the face, especially the nose
Understanding the importance of common 'red flags' that should be brought to providers attention (latex allergy, Hx of narcotics abuse, overly anxious pt, defibrillator or over implanted device that would preclude electrocautery use)
Understanding how to keep a clear field for the provider to see (blotting blood)
Understanding how to take photo (inc. what angles are best for each location)
Making sure all CLIA reviewed aspects are in every chart and reviewed for accuracy - Mohs Maps, pathology accession numbers, site locations, specimens are legible, spelled correctly and in order. There should be mention of what is required for CLIA licensing maintenance and what goes into the audit
Anticipating surgeon’s and patient’s needs so you’re ready before they have to ask
Surgical assisting (proper handling of instruments, when to blot, where to hold pressure, where to keep your hands, and how to cut buried sutures properly - short tails without cutting the skin or the knot)
How to draw up anesthetic
Cauterization techniques
Why local anesthetic causes pain and how to inject appropriately
How to pass instruments
How to sterilize equipment
How to perform a wound culture
How to take a BP
How to handle difficult patients
Why it’s important to keep patients informed
Importance of communication
How to cover slip slides
How to run a sterilizer and ultrasonic cleaner
Sharps training
Types of biopsies
Identifying high risk patients – transplant patients, patients on immunosuppression
How to triage postoperative concerns via phone or in the office
Importance of MohsAIQ (ACMS)
Roll of the Mohs histotech and lab procedures
Trust between surgeon and assistant and need for honesty
Mohs Lab Tech training - how to mount, cut, dye - why these things are done
Explaining path results to patients
Proper coding of multiple blocks, layers, and flaps, sites
Being able to differentiate skin edge, dermis and epidermis and SQ while utilizing
Data entry for the repairs (repair type and measurements)


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