Surgical Boot Camp at UNMC

(To the tune of Piano Man)

It’s 9 o’clock on a Friday morn. The regular crew shuffles in.

They’ve all matched into residencies, but just before they begin:

Chickew…record scratch: BOOT CAMP.

A three and a half-week, elective course for M4s to hone their surgical skills just before graduation.

Did I mention it was optional? And that all 20 UNMC students who matched into surgical specialties opted to do it?

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Here are the overachievers with boot camp organizer Dr. Wendy Grant on the far left. Surgical Resident and Alex Trebek wannabe, Dr. Jeff Carson, is on the far right. On the first day, Dr. Grant buys them camouflage hats and labels them with the students’ last names. They can wear the hats during the month, but Dr. Grant asks for them back just before the end. On the last day of boot camp, she returns the hats back with “Dr.” before their last name.

They could be sleeping in, going out, traveling abroad, goofing off, wandering around, but they’re not.

They’re in the basement of the cadaver lab, tying knots on the incisions of donor bodies. Knot after knot after knot so that when called upon to suture in the operating room, they don’t freeze. Start to shake. Or worst-case scenario: get passed over from someone who does know how.

Surgical boot camp, now in its third year, was designed by Wendy Grant, M.D., from the Department of Surgery. She organized it to give UNMC students a leg up (or would it be a hand?) when they begin their careers as doctors later this year.

“Knot tying is the most basic, fundamental surgical skill,” Dr. Grant said. “If everyone who comes through here can be called on to tie a knot on their first day, whether it’s right-handed or left-handed, they’re ahead of the curve.”

You won’t catch Dr. Grant barking at students to “drop and give her 20” knots, but instead sketching a pancreas on the white board and peeking over the scrub-donned shoulders of her students with pride.

Thanks to those who donate their bodies to science, this course gives students the most accurate representation of what tissue will feel like in the operating room. Ortho students focus on the bones and joints. Obstetricians and gynecologists zero in on the uterus. ENTs and neurosurgeons concentrate on the head and neck.

“It’s the ultimate simulation,” said Ben Grams, who matched into general surgery at UNMC. “Having the cadavers makes it so much easier to learn as opposed to looking in a book.”

Jeremy Hosein, who matched into neurosurgery in Colorado, is practically boy scout status after tying so many knots.

“I’m 1,000 percent better,” he said. “We’ve each now tied a couple thousand knots.”

It’s not all knots. The mixture of advice and teaching comes from faculty and residents in many areas of surgical specialties at UNMC. There’s also the Laparoscopic Skills Olympics and of course, Jeopardy, held in the Medical Services Building.

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With categories like “Things that are Red?” (Solo cup not being an acceptable answer) “The Number After 2,” “It’s Not a Toomah,” “Orders in the OR” and “X-ray,” it’s hard for the students not to have fun. After four years of non-stop studying, they relish the relaxed environment of “boot camp.”

“It’s an opportunity to reconnect with everybody,” said Jennifer Dwyer, a soon-to-be urological surgery resident at UNMC.

Dwyer brought the bagels and coffee for her team on the day of Final Jeopardy. After correctly writing an order to “administer a fluid challenge to a 19kg child who is hypotensive,” she and her teammates were stumped by what foreign body was pictured on an X-ray.

Fishing bobbers, guessed one student? Nope. Another student shouted an answer that can’t be printed in this blog. Nope. The answer was magnets. Giggling ensued.

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Tom Brush holds up his team’s answer to a surgical Jeopardy question.

Their final exam was a double elimination bracket of tying 10 knots with fine suture. For many, having to do so will never be a part of their everyday lives, but it was a skill they thought impossible just three and a half weeks ago.

They opted to be here because they know it’ll make them better.

That, and it’s fun.

Show Me That Smile

 

The following is the second in a series of guest posts by UNMC third-year medical student Eric Nagengast, who is taking a year off from med school to  serve with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

I have no need for an alarm clock in Guwahati.  Like the roosters on the farms of Nebraska, the crows here alert everyone to the first sign of daylight around 4:45 a.m. At 5 a.m. the drivers begin bleating their horns on the street below, and by 5:30 a.m. the elder men of Guwahati clear their lungs, throats and sinuses with an aggressive, hacking cough. After years of breathing the Indian air, I probably would have to do that too, but the sound is certain to end any hope of a few more minutes of sleep.

I get up and efficiently use the 60 seconds of hot water my shower allows me each morning. A long hot shower is one of the things I miss the most about home. After a quick breakfast of one of the twenty protein bars I brought with me, along with some local fruit, I am out the door and thrust into all that is India.

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The streets of Guwahati.

India has a way of overwhelming all your senses all the time. The first thing I notice is the thick, polluted air. I will never get used to it as it’s my least favorite thing about Guwahati. The air is so polluted that some members of the team use an inhaler. Next is the noise. On my walk to the hospital, I am honked at by rikshaws, cars, buses, motorbikes and bicycles. In India it is custom to honk anytime you are approaching another vehicle or a pedestrian. Since the streets are crowded with both, the result is continuous honking. Of course, I see plenty of things that would be completely out of the ordinary back home like monkeys, massive amounts of garbage or a fight between stray dogs.

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You can imagine why everyone in the Delhi airport double-and triple-checked my connecting flight. Why would an American want to travel to this poor, isolated part of India?

When I step into the ward, I am reminded why I am here. The most deserving patients in the world fill the large room full of 40 hospital beds and today they will receive care they have waited many years for. The operating room in the Guwahati Comprehensive Cleft Care Center is just awesome! I learn so much assisting the expert surgeons here. There is not a center in the world that does more cleft operations.

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Nagengast assists a surgeon from the Democratic Republic of Congo who spent four months at the center learning cleft surgery. Before arriving he had never done a cleft operation. The surgeon, who goes by Desi, is now back in the Congo providing care for his people.

Yesterday’s patients are being discharged and today’s are undergoing preoperative assessment. I look for patients to interview for our quality of life study. Our goal is to determine how living with a cleft affects the quality of life for a person and his or her family. I interview a 14-year-old boy and his father. This boy has a cleft palate. His father makes $3 a day mining coal. For 14 years, this boy has lived with a defect in the roof of his mouth that leaves his nasal cavity open to his mouth. You can imagine the difficulties this has caused with speech and eating among other things.

The next patient is a 40-year-old woman with a cleft lip. This woman has lived 40 years without seeing a surgeon for something that would have been fixed at three months of age in the United States. At the center, I have seen patients as old as 65 with unrepaired clefts. I will say it again; these are the most deserving patients in the world.

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Patients without access to surgical care exist in many parts of the world. It is not just cleft lip and palate that they suffer from, but also obstructed labor, injuries, appendicitis, and on and on. Most of you reading this probably have had at least one operation, and if not, someone close to you has. What would life be like if you did not have access to safe surgery?

The greatest advancement in surgery in the coming decades will not be a new, high-tech invention. Instead, it will be finding a way to deliver surgical care to the people who need it most, and I hope to be a part of this discovery.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.

Taking a Year (of a Lifetime) Off

The following is a guest post by UNMC third-year medical student Eric Nagengast.

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For the past eight months, one of the hardest questions for me to answer has been, “Where do you live?”

In this time, I’ve spent two months in Rwanda, three months in Boston, one month in India and the rest of the time between Nebraska, Colombia and a few other countries.

Since I’m a medical student, people wonder how I’m able to spend so much time away from school. I’m able to travel because I took a leave of absence from medical school between my third and fourth years.

Yes, it may seem crazy, but I actually agreed to put an extra year between myself and the elusive M.D. because I am spending this year as a Paul Farmer Global Surgery Research Associate with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

At PGSSC, we believe safe surgery is a right that all humans should have. Through research, advocacy and clinical assistance, PGSSC strives to bring safe surgery to the people of low- and middle-income countries.

Historically, surgical care has largely been left out of global health priorities. So our battle is not an easy one.  Our group is composed of physicians from the affiliated Harvard hospitals, fellows, residents, students and support staff from multiple schools, countries and continents.

 I am writing this post 30,000 feet above the middle of the Atlantic Ocean, four hours into a 14-hour flight from Newark to Delhi, the major leg of what is bound to be around a 30-hour trip to Guwahati, India.

In the last six months, I have grown accustomed to spending large chunks of time in airports and airplanes. One can actually get a lot done crammed between a couple of strangers for hours with no contact with the outside world (that is, of course, once one has seen every movie the in-flight entertainment has to offer).

Along with traveling, I also have grown accustomed to leaving the luxuries of the western world behind (such as hot water and easy access to food), and I am actually looking forward to my next few months abroad.

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Nagengast with children at a refugee camp in Rwanda for those from the Democratic Republic of Congo.

In India, my team and I are working on a number of research projects in joint partnership with Operation Smile, an international cleft-care organization. Through these projects, we hope to give a voice to the voiceless. We hope to show the great need there is for surgical care throughout the world, and we hope to show this need can be treated in a cost-effective and safe manner.

While I am in Guwahati, I will be lucky enough to scrub in to cleft surgery with some of the world’s greatest cleft surgeons. For a medical student with the goal of becoming a plastic surgeon, this experience is a dream come true.

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Nagengast (left) assists Dr. Bill Magee on a cleft palate surgery at the Operation Smile Guwahati Comprehensive Cleft Care Center in India. Dr. Magee is Operation Smile chief executive and co-founder.

could not share my story without thanking those who have supported me and helped make my experience possible. In particular, I would like to thank my family and everyone behind the Nellie House Craven Scholarship.

This year is undoubtedly the best year of my life. I have met the most amazing people, I have seen the most amazing things, and I now have a vision of what I would like to do with my future. Most importantly, I am the happiest I have ever been.

I will return to UNMC a better clinician, a better researcher and a better person. I hope my story inspires more UNMC students to consider taking less traditional paths toward their degrees.  

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Stay tuned for my next post on a day in my life in Guwahati, India.