One Night on Trauma Call

The Pioneer – Looking Back, The Educator – Looking Forward

All it took was one night on trauma call at Cedars-Sinai to realize that despite the location, the beautiful environment, and the state-of-the-art facilities, surgery patients are the same wherever you are.

I came to Cedars-Sinai in the fall of 2007 from the Los Angeles County + University of Southern California Medical Center—the largest county hospital in the United States. I had recently completed my residency and fellowship there, and served as a junior attending physician. Coming from a county hospital in East LA, Cedars-Sinai seemed like another world to me.

When I was offered the opportunity to join the faculty at Cedars-Sinai and took a closer look, however, I realized that what I thought I knew about Cedars-Sinai was markedly different from the reality. Whether at a county hospital in downtown Los Angeles or at an academic medical center on the West Side, our patients all want the same thing: for their surgeons to offer them hope and the ability to restore their health. And this is why surgeons chose their profession in the first place. As one of my mentors told me, we have the ability, as surgeons, to help people retain or regain their health.

Mentors are an important force in determining our future choices. In many ways, most of what we do is shaped by the people we look up to. I was fortunate to have outstanding mentors who helped me become the person and surgeon I am today.

The quality they all shared was their commitment to teaching others. For them, teaching was a responsibility as serious as any other.

They instilled in me the belief that the role of a teacher is to inspire, to instruct, to stimulate, and to expand the aspirations of others. A mentor should enlighten you to new knowledge, but, just as importantly, teach you to never forget your limits: When you start thinking that you have all the answers, when you get a bit too confident and arrogant, that’s when bad things can happen.

When I was growing up in New York, I had several close friends whose fathers were pediatricians and surgeons. I deeply respected my friends’ fathers, and already knew that I wanted to have their job. In hindsight, it had a lot to do with the way they carried themselves. They seemed to know so much. They were confident. They were impressive. I was in awe of them.

These were people who had high expectations of themselves and of others. They expected excellence, and I did everything I could to prove myself to them. To this day, I expect excellence of myself and others. In our line of work, we can never cut corners, because the people who would suffer are the same people whose care we have been entrusted with.

The tradition of mentorship, education, and surgical excellence established by Dr. Leon Morgenstern when he was director of the Department of Surgery continues with our current chairman, Dr. Bruce Gewertz, and is what brought me to Cedars-Sinai. Then I was given the opportunity to become program director for the general surgery residency—to take part in educating the next generation of surgeons. It was a chance for me to mentor others just as I was once mentored, and this has become, without any doubt, the most fulfilling aspect of my job.

Nearly 40 percent of all medical students who apply for surgery residency in the U.S. apply to the Cedars-Sinai residency program. They represent the best and the brightest from the top medical schools around the country. I believe these students pursue surgery for the same reasons that Dr. Morgenstern and others did nearly 60 years ago, even though the practice of surgery has changed significantly.

In the last 10 years, a dramatic sea change has occurred in surgery. Minimally invasive and catheter-based techniques have been developed for procedures we used to perform as open surgery (maximally invasive). Recent scientific discoveries, coupled with the use of the Internet, translate into a rapidly growing body of knowledge and the ever faster exchange of information. Our understanding of many diseases is quickly changing, and the way we manage those diseases is therefore changing rapidly as well. For example, we now know that patients who sustain certain injuries after trauma can safely be observed without the need for exploratory surgery, something that was unheard of just 10 years ago.

Developments such as this, while beneficial to our patients, also make surgical education more challenging. The old adage “see one, do one, teach one” is no longer applicable. Training directly on patients is not tolerated today. Patients expect their surgeons to be highly competent before they are allowed to operate on them. In an effort to strike the ideal balance of educational needs and patient needs, our teaching program has adopted techniques and approaches such as working in well defined skills laboratories, training on inanimate devices, and using simulators that allow our residents to become proficient before they ever enter the operating room.

As part of our training, we also teach our students, residents, and fellows that, when they are in the operating room, they must develop a strong team partnership with those in the room. To truly be efficient and to do the best job possible, we must be able to rely on the people around us and, most importantly, we must know how to work together.

Fortunately, a new field of education now focuses specifically on team-based learning. In the past, we learned about teamwork simply by watching. We are doing a better job today of actively teaching these skills. We understand now that working together as a team is essential to providing top-quality patient care. That’s why the skills and simulation laboratory plays such a vital role. We can simulate in the lab a situation in which surgeons urgently need to work as a team. We use this approach frequently with the trauma team, for example.

It would be presumptuous to speculate on what surgical technology or education will look like in the future. However, the universal desire of surgeons to help their patients restore their health while mentoring the next generation of surgeons will hopefully never change.