Tie. Tie. Tie.
That's the take-home message as the first week of surgical boot camp begins. It's delivered by Dr. Mary-Anne Purtill, a trauma surgeon with the vocal range of a drill sergeant and the good cheer of a natural teacher.
"What's the general principle of knot tying? What about the jerk at the end of the knot?" she barks. "It's you, right? So don't tie the knot too tightly, or you'll strangulate tissues."
As Purtill describes friction knots and one-handed knots, the 12 first-year surgical residents listen and continue tying. Over and under, around and through, they tie two-handed square knots, working with a rope that's half purple (to distinguish the short end) and half white (long end), perfecting nice, loose loops. "Rope is fun," Purtill says, patting a would-be neurosurgeon on the shoulder. "But try to get some suture from the OR, and use it to get good motor memory. Then tie, tie, tie."
Early in their first year of residency, the surgery students are spending a week at the Goodman Simulation Center on the third floor of Stanford Hospital. In the University's newest simulation center—the two others are at the Palo Alto Veterans Hospital and at the Center for Advanced Pediatric Education in the Stanford Barn—novices practice their suturing skills on part-task trainers (simulation devices) and learn how to insert chest tubes and catheters on a life-size mannequin that bleeds, breathes and moans.
"In our lifetime, we'll see mannequins you can do cardiac surgery on," says Sandi Feaster, program director at the Center for Immersive and Simulation-Based Learning. But for now, it's mostly residents who are being trained at the Goodman center, which includes a brightly lit room that can double as an operating suite or intensive care unit.
With biopsy pads students can practice suturing wounds. Or they can inject pain-numbing Lidocaine (which looks suspiciously like blue dye) and slice into the lifelike fatty tissues of a lipoma pad. Catherine Mohr, MD '05, an instructor in the department of surgery, walks from table to table, handing out Adson forceps and needle holders. "Practice with them in your pockets," she says, encouraging the newbies to carry their instruments as they walk the halls of the patient wards.
The center's technology is so drop-jaw new that cardiac surgeons stop by to peek at the gadgets. By donning 3-D glasses, students and surgeons alike can explore an interactive atlas of skull osteology that is projected onto a wall screen. As the front of the skull is "exploded," revealing cranial nerves and a mandible, surgeons will be able to peer through the eye sockets into the interior and plan procedures. On the mannequin in the adjoining OR, residents can learn to place central lines and perform tracheostomies.
For all the wow, it's Bedside Manner 101 that drives Purtill's interactions with her students. "It's important this year that you develop a sense of tissue," she says, as they manipulate unfamiliar scissors and scalpels. "Use your fingers as blunt instruments, and pay attention to how these things feel."
The good-hearted sergeant stops to look over a knot newly tied by an aspiring orthopedic surgeon. "Don't overthink it," she adds, patting him on the back, moving on to the next experiment in macramé.
