Northern Surgical Skills Conference, UK

The Northern Surgical Skills Conference (NSSC) is a national conference held in UK in order to give medical students a better understanding of what a career path in surgery entails. The conference is an all-day event that features guest speakers from the field, opportunities to practice basic surgical skills, such as suturing and laparoscopy, and presentations from student researchers.

As a member of the 2014 NSSC Committee, I have had the rewarding experience of planning and coordinating this year’s event that is to be held on Saturday, May 17th. As we are drawing closer to the date and finalizing the last details, I stumbled upon a reflection that I wrote after attending last year’s conference as a first-year medical student. I feel that the piece highlights the importance of early exposure to different specialities for medical students; especially considering how the medical world is becoming filled with ever-increasing niche roles, requiring students to distinguish sooner-rather-than-later the path they wish to take.

 

This year’s Northern Surgical Skills Conference was held on May 11, 2013 at Hexham General Hospital in order to give current MBBS candidates a better understanding of what a career in the surgical field would entail. The event featured surgical technique teaching sessions, guest speakers currently working in the field, and student-led presentations, offering a dynamic mix of activities to engage students and widen their perspective on the profession.  Although attendees were split into groups and rotated around an activity circuit, every group was able to participate in all aspects of the conference; speaking sessions were conducted as a single group.

Of the plethora of events being held, the Laparoscopic Skills session was particularly popular among participants, as it offered students the hands-on experience of wielding essential tools familiar to a surgeon. The session was conducted in pairs using laparoscopic instruments on the abdomen of a training mannequin containing a triad of keyhole incisions: one person directed the laparoscope-camera through a single incision; the other managed the typical clasping-instruments in either hand through the remaining two. While observing the monitors depicting the inside contents of a hollowed out abdominal cavity littered with sugar cubes, the individual operating the two clasps was challenged to stack the cubes into a tower as high as possible. Adjusting to the new sensations of grasping, turning, lifting, pushing and pulling through a medium, rather than directly by hand, caused lips to be bitten and eyes to be fixated on the screen as the participants employed their full concentration. Although the contents of the mannequin were empty save for the sugar cubes—far from the anatomical reality of an actual human—the exercise stressed the patience and dexterity needed to manipulate the instruments. “Slow, small, and specific movements” were key, which seemed to be challenging enough given the amount of excitement. Students could only imagine how much more difficult it must be during a live surgical operation, when the hands of the clock ticking. Moreover, the activity served to highlight the importance of teamwork in surgical procedures, as the camera person played an equally critical role, constantly adjusting their position to grant sight and the best vantage point to the instrument-holder.

Such sessions were sandwiched by talks given to the entire assembly by a number of leading surgeons and medical professionals. Among this cohort of outstanding speakers, vascular surgeon Mr Mike Clark discussed a topic that stood out as one more unique and often underrated in the field: the Human Factors in surgical medicine. Clark attempted to deconstruct and dispel the infamous trope of the brilliant surgeon who, though scientifically adept and a technical genius, is simultaneously cold, anti-social, and removed from emotional connections. He argued this to be a major fallacy within medicine in need of immediate repair. Surgeons are not only required to be in sync with their patients and medical team, but there is also a strong need for being aware of one’s own emotional status, especially in times of error or when things do not go as planned. Considering the former, Clark gave anecdote of a time when he was asked to come in as emergency aid on a vascular surgery that had gone awry in the RVI. “In cases like this you have three options,” he stated, “you can: 1) scrub-up, take over and begin leading the procedure; 2) scrub-up and take on a supportive role; or 3) do nothing.”

While there are those who are tempted by the glory of the first option, wanting to be the one to save the day, he reminded the conference that in times of crisis, taking on a supportive role allows one the opportunity to do additional thinking that the lead cannot accomplish, due to stress. Furthermore, he also advocated for openness and acceptance that mistakes will happen on the job as a cause of human error. Physicians are often tremendously criticized for professional errors that arise, which subsequently breeds a culture of secrecy and crippling self-guilt among medical professionals. Instead, a culture where errors and mistakes are openly discussed and evaluated may not only lead to greater transparency and a healthier work environment for doctors, but may also promote a safer medical arena on the whole. As with the previous Laparoscopy exercise, teamwork was emphasized as a crucial part of a surgical career—not only within the more intimate setting of the operating room, which demand both effective communication and willingness to work and interact with others, but also as a collective whole to progress the field for everyone’s benefit.

Finally, towards the end of the conference, students who had been hand-selected by a group of judges were invited to present research posters they had submitted prior to the conference. The three chosen finalist impressed the room with the streamlined and high-quality work they produced from their experiences in clinical hospital settings. Ultimately the first prize went to a young man who had run a case-control study comparing the outcome success of hip replacement surgeries using a Caliper measuring device, versus those in which the device was not used. The study design was elegant: comparing post-operative data and x-rays, he demonstrated that a statistically significant difference existed between the two groups; surgeries using the Caliper had higher rates of symmetry between both legs and higher overall success rates. Such data has direct clinical implications and serves to emphasize the importance of not only having access to medical tools and technologies, but also employing patience and taking the time to use them properly for the best outcome possible.  Indeed if Teamwork was the primary theme throughout the day, Patience was a close runner-up as one of the most important traits in becoming a surgeon.

Medicine is such an extensive field, housing almost an infinite number of options, specialities and career paths — which is one of the reasons I was personally drawn to this field in the first place. However, with opportunity comes the burden of choice. Speaking with my peers and some of the junior doctors, it is clear that picking one’s field is not a simple decision to make; with specialities becoming ever more niche, I have seen that those who are still in the earliest stages of their medical careers already feel overwhelmed by the making such a decision.

That is why events such as the Northern Surgical Skills Conference play an invaluable role for medical student—especially those who have little exposure to clinical settings and specialty work, but would do best to start preparing as early as possible for rigorous career paths, like surgery. I myself do not know at this moment whether surgery is the right option for me, but I can say that from what I have seen thus far, I am most certainly not ready to rule it out. I suppose what it comes down to is understanding your own strengths and weakness, analyzing you skill-set, and then choosing a path that meshes with those observations and allows you to affect as many lives as possible for the better. Ultimately though, some of that process comes from intuition and some of that only becomes apparent with experience. Either way, I feel like I am one step closer to discovering the answer.