Residency Opportunities: Training in Endoscopic Surgery

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Tom Lyons, MD: Hi, I am Tom Lyons and I am here to discuss a topic with some friends of mine. It is near and dear to our hearts in laparoscopic surgery and endoscopic surgery. For a number of years, we have all been concerned - and I think that is part of the goal of AAGL - to be concerned about the education of the next generation of surgeons in endoscopic surgery. Our goal has to be accomplished, I think, through good resident education. Recently, we have been working with the Atlanta Medical Centre and Dr. Rhonda Latif in order to begin some modular training in resident education. Our goal is to try to find some measurable method of determining the progress of our residents in their attempts at obtaining skills that at times are pretty daunting. Dr. Latif is here and I would like to ask her a couple questions with regard to her goals in this residency training program. Rhonda, again, we started thinking about this over a year ago and we initiated some things. What do you think our goals need to be?

Rhonda Latif, MD: Well, Tom, number one: the reason that I became concerned about the education of our residents in minimally invasive surgery; hysteroscopy and laparoscopy is the results of a Kreog survey last year, which revealed that most program directors do not feel that we have enough facilities and capabilities in terms of faculty, equipment, and time in order to adequately train the residents; and residents when they graduate do not feel comfortable doing some of the more advanced laparoscopic procedures. The goal we have is to, of course, have our residents exposed and feel comfortable when they graduate and they go out into practice and take care of women and are able to offer them these new and innovative surgeries, and that is just not happening. We have to develop a program so that residents are not having that learning experience in the operating room. I would like to think the old adage, “see one, do one, teach one,” is no longer something that the public is going to be willing to accept, and rightly so, it is not safe. We have to have some way to train residents in an environment that is like it is in the operating room so that we can say, okay, they have done step a, step b, and now they are ready to enter the operating room and do live surgery with confidence.

Tom Lyons, MD: Thank you. Also with us is my surgical scrub nurse and an expert on her own in laparoscopic surgery and hysteroscopic surgery. She has been integral in this process, also, because not only are we training these individual new surgeons, but we are also training those people around them who are going to make them successful or not. Wendy Winer and I have worked together for 11 or 12 years or something like that. It only seems like a few minutes to me, but I guess it has been longer than that. Wendy has a long list of educational experiences. She has participated in AORN training sessions and really is responsible for some of the information that is now being dispersed to the nursing and OR personnel. She has conducted a post-graduate course here at AAGL. Wendy, what do you think your role is? What do you think the role of the OR team is in this process?

Wendy Winer, RN: Well, I just wanted to mention that it has been a few long minutes, but they have been great. Actually, I think the OR personnel and OR team really do play a key role. One of the things we really want to stress when we are training residents is that they really need to work with their OR team because it definitely is a team process. One thing we include when we do the residency training is to include a section on set-up of the operating room and instrumentation and equipment, and for the residents to learn from the outset that they really need to know themselves how everything in the room works and not to rely on anyone because their staff may vary from one case to another. In addition to that, though, we are training the OR team alongside the residents because, as I said, it is a team process and your OR staff can really make or break you. It is important that the OR team understands the anatomy, understands the procedures, the instrumentation and equipment and really facilitate the procedure by making the whole set-up in the operating room pleasant and nice and efficient for the physician so that the resident, when they go out to practice, the physician can really focus on giving the patient the best possible care and not always have to worry about every teeny, tiny detail, even though ultimately they are responsible. I think the key is to train everybody together at the same time.

Tom Lyons, MD: Thanks. Again, Rhonda, we have had the experience now of going around and looking at a number of the training instruments that are out here and available to us. Some virtual reality things, some of these other boxes and simulators. What do you think about these things?

Rhonda Latif, MD: I think it is a promising future for our mission of training residents. Again, I have some problems with how we are going to relate that to everyday surgery in the operating room, but I think there are enough good talented people who are interested in promoting resident education and I feel confident in the years to come that we will indeed, Tom, be able to feel comfortable and have these new graduates going out and doing these surgeries.

Tom Lyons, MD: Thanks. We appreciate the ability to get this information across to the OBGYN.net folks and thanks again.

Note: For more information on the resident training program please see http://www.aagl.com or http://www.amc-gme.com/