Practice may make perfect, but it also makes for great education in the multi-surgical specialty cadaver lab for fellows, residents, and students from the Kirk Kerkorian School of Medicine at UNLV.
On a recent September day, just such a lab was presented for all postgraduate year (PGY) levels, including several graduate medical education programs, fellows in trauma, and residents in general surgery, plastic surgery, and OB/GYN surgery. This eight-station lab was carefully structured by PGY competency level.
- Level 1: Knot tying, suturing, aseptic technique, basic procedures
- Level 2: Respect for tissue, developing skill in instrument handling, moves through portions of procedures without coaching
- Level 3: Proficiency in handling of most instruments, efficiency of motion during procedures, moves through most procedures without much coaching
- Level 4: Proficiency in use of instruments and equipment for essential operations, guides the conduct of most operations and makes independent operative decisions
“Overall, I liked how they split it up because they did it so there were different levels at each station. The chiefs got to practice taking us through the surgeries, so it was nice having the different levels at each station.”
So, how important are these labs for aspiring surgeons?
“They’re extremely important,” said Nadia Gomez, MD, interim chair of OB/GYN, director of minimally invasive gynecology and robotic surgery, and associate professor of OB/GYN. “One of the main things I always tell my students, my residents and medical students, in particular in surgery, is that a safe surgeon is one that always knows their anatomy. Above anything else, we practice surgical skills and procedures, but we also are reviewing the anatomy of these specimens, because the more anatomy you’re familiar with in the operating room, in your surgical field, the safer you feel as a surgeon. Your confidence goes up and safety goes up.”
It’s also a way for faculty to teach them in a risk-free and stress-free learning environment.
“Because if you’re teaching them in the operating room,” said Dr. Gomez, “the stakes are high. You’re worried about time, you’re worried about safety. So, this is a once-a-year lab that allows you to teach them in a safe and non-stressful environment.”
It also provides neophyte surgeons with the chance to practice procedures they may not ordinarily be able to.
“The thing that is most important that this lab gives to our residents is the chance to carefully go through procedures that they don’t necessarily always have the opportunity to do,” said Dr. Jocelyn Burke, assistant professor of surgery, minimally invasive surgery (MIS). “They can be rare procedures because the indications for that procedure may not be prevalent in the population. Because we don’t have a bariatric program, for instance, and so they don’t get to do a lot of bariatric procedures right now… It gives them a chance to go through procedures that they need to know to be good general surgeons in a format where they don’t have to focus quite so much on how the patient is doing under anesthesia, that sort of thing. They can focus on the anatomy, they can focus on the steps, and they can do multiple procedures on the same donor, so they have the chance to do the procedures they are less familiar with in a safe setting.”
Resident Elks, who wants to apply for a fellowship in bariatric surgery, agrees. “We were able to practice cases that we don’t normally get to do or that we don’t have as much exposure to. I got to do one of the bariatric procedures … the gastric sleeve. And we don’t do bariatric surgeries at our institution, but it is something I want to do in the future. That was the first time I got to perform it.”
Having several disciplines in one lab is extremely beneficial, as well.
“I like the multi-disciplinary aspect of the lab because we had some instances where a general surgery resident might want to practice hysterectomy because they might be going somewhere to practice rural medicine and they need exposure on that,” said Dr. Gomez. “And the same goes for an OB/GYN resident wanting to do an appendectomy … so there are different procedures that they can see and they can get that exposure to.”
The multi-surgical specialty lab is conducted once per year, dependent on funding.
“How many stations we set up or what we’re able to do with our learners” is dependent on the funds, said Dr. Gomez. “If we have, for example, 6 specimens, we can do more things. If we only have 2 specimens, then we have to condense the type of procedures or surgical skills that we’re teaching them.”
“Labs are based on the funding that we have,” said Dr. Gomez. “So, each lab consists of different specimens or tissues. The most expensive aspect of the labs is the tissues, which tissue can mean cadaver or specimen.”
For this year’s lab, 50 percent of the funds came from the school and 50 percent came from the industry partner, Ethicon, a subsidiary of Johnson & Johnson. The lab generally runs five to six hours.
“From a resident standpoint, it’s funny,” said Dr. Burke. “We joke that we can set up a lunchtime, but no one takes one. No one takes breaks. They’re so focused and interested in the cases going on and learning and doing, that they skip their lunches and skip their snack breaks because they love being there. It’s hard to pry them away from their learning opportunity.”
But the students aren’t the only ones that are giving it their all. Without the commitment of faculty and staff, these labs would not be possible.
“It’s always so refreshing to see the dedication that my colleagues have to our students and our residents’ learning,” said Dr. Burke. “To make sure we had great candidates (cadavers) for our residents, to everyone who shows up throughout the day to spend their time teaching these residents multiple procedures and going through everything with them. To all of our support staff who dedicated hours and hours and hours of time before the lab to make sure it was a successful endeavor for everyone. It’s so nice to see that we’re all so dedicated to them learning and being the best physicians, surgeons and GYN surgeons.”
And there is one other important group whose contribution is the ultimate key to the success of these labs.
“This wouldn’t be possible without people agreeing to donate their bodies to science when they die,” said Dr. Burke. “That’s another thing that we’re hugely grateful for. And the attitude that people have to support education when they no longer need their body parts is fantastic. It’s another thing that people in the community can do, even if you can’t be an organ donor, you can be a tissue and bone donor and you can donate your body to science. This provides an extremely beneficial and unique learning experience for people.”
The Kirk Kerkorian School of Medicine at UNLV is greatly appreciative of anyone considering donating their body to science, which benefits the education of future doctors and surgeons. While the school does not currently accept such donations, interested parties may learn more about organ and tissue donation by visiting the Nevada Donor Network website.
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KIRK KERKORIAN SCHOOL OF MEDICINE AT UNLV
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