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Skills Lab helps prepare medical students for surgery clerkship

Third-year medical students practice knot tying, suturing, intubation and more before they spend six weeks in hospital operating rooms under the supervision of attending physicians.

Hassan Zbeeb, third-year medical student, operates a colonoscope and extraction device as Tiffany Killblane, M.D., first-year surgery resident, offers advice
Hassan Zbeeb, third-year medical student, operates a colonoscope and extraction device in the Surgical Skills Lab as Tiffany Killblane, M.D., first-year surgery resident, offers advice.

With both hands on the controls, Hassan Zbeeb slowly backed a colonoscope and extraction device out of a simulated intestinal tract and revealed his prize — a piece of makeup sponge standing in for a polyp.

“Look at that, a biopsy,” said Tiffany Killblane, M.D., a first-year surgery resident instructing Zbeeb in the procedure.

“Put it under the microscope now!” Zbeeb said.

This year, Zbeeb and other third-year students at KU School of Medicine-Wichita started spending half a day in the Surgical Skills Lab at Ascension Via Christi St. Francis during the first week of their eight-week surgery clerkships. The lab gives them experience with knot tying, suturing, intubation, and other common techniques and procedures before they spend six weeks in the hospital’s operating rooms under the supervision of attending physicians. They also attend lectures and visit the cadaver lab at Newman University during the clerkship’s first week. The last week is when they take their final or “shelf” exam.

Mary Thompson, the lab’s coordinator, joked that the students “have played enough video games. This should be a piece of cake.”

But as they concentrated on the various tasks in the lab, it was clear that the physical dexterity required is akin to the mental dexterity expected of physicians.

“I’m literally probably going to have a blister,” Michala Siefer said after maneuvering the handles on the laparoscopic training box. “I was just putting so much pressure on these.”

medical students practice surgery simulation in the skills labAnother student, Marissa Ritter, called the colonoscopy station “pretty difficult, especially when you have to do both (controls) at the same time.”

Located on the third floor of St. Francis, the Surgical Skills Lab is primarily used by surgery residents and fourth-year medical students who are planning a surgery residency. The half-day sessions for third-year students were added so that they would have an overview of surgical procedures at the beginning of their clerkship, said Marilee McBoyle, M.D., director of the lab and professor in KU School of Medicine-Wichita’s Department of Surgery.

In the lab, if they make a mistake, no patient is affected. But as they were repeatedly reminded, the mastering of these procedures is just as important as the ability to diagnose and prescribe.

Jacob Lancaster, M.D., a second-year resident leading the training, told the group that one of his pet peeves is seeing a poorly executed suture.

“If you don’t want something on your body, don’t leave it on a patient’s body,” Lancaster said. “These are people. This is real life.”

Lancaster added that patients may judge their surgery by what they can see — the suture on the outside of the body. “It’s just perception.”

The session allowed Lancaster, Killblane and another resident, Nathan Maginnis, M.D., to pass on tips. Lancaster noted that when tying sutures, “tension is everything.” Too little and a wound may open, too much and it could cause skin to die.

Lancaster compared operating laparoscopic instruments to “backing up a trailer.”

“It’s the opposite of what you’re doing. If you go down, you go up.”

medical students practicing suturing in the skills labKillblane told students that one internal body part they’ll see while performing a colonoscopy “is going to look kind of like a fish’s mouth that is spitting at you.”

Like most or all of the students, Wyatt Bell said he was already somewhat familiar with the techniques from attending “procedure nights” conducted by the school. But he welcomed more practice before starting the operating room part of the clerkship.

“Now I’ll have a more responsible role.”

Added Siefer: “It makes it less intimidating when you go in and do it on skin.”

Lancaster told the students that the surgical clerkship “is probably one of the more hands-on rotations,” and Killblane agreed, saying that it helped her decide her specialty.

“After my surgery rotation, I just really loved the people I was working with. The attendings were really involved” in teaching students, she said. “I just enjoyed doing things with my hands and watching patients improve.”

A laparoscopic peg transfer, pictured in the photo at left, is among the skills practiced in the Surgical Skills Lab, along with knot-tying, pictured in the lower right photo.

KU School of Medicine-Wichita