Practising surgical skills at (someone else’s) home

I should start by saying that until recently, I had never really considered a career in surgery as a possibility for me. Perhaps it has to do with the rather “basic science” perspective of my preclinical experiences, but I have always found myself more comfortable with thinking about diseases and treatments along (what some might consider more boring) biochemical lines rather than physical and anatomical ones.


However, lockdown and the ‘onlinisation’ of much of my university’s preclinical teaching resulted in me spending several months staying with a close friend of my sister’s, who also happens to be a urology trainee. There, I encountered a rudimentary laparoscopic simulator he constructed years ago using a small camera attached to the platform of a music stand which is placed on an ironing board (the only one is his house – he never seemed to use it for any actual ironing).

The first few times I tried it were mainly out of lockdown-induced boredom. However, things became more fun when he explained the concept to me in more detail.


The goal, he said, was not simply about stacking hoops on poles or suturing pieces of foam together. Rather, it was about accomplishing the tasks with speed, accuracy, and efficiency.


He would play on the far more advanced laparoscopic simulator at his hospital before coming back and telling me about it, relaying feedback given by his consultants. I saw and tried to emulate how he worked on making

each motion controlled and purposeful, while limiting the action to a small area around the target location. Every aspect could be optimised – the sequence of movements, the rotation of the instruments, the way I gripped them, my body posture... There was an element of subjectivity too: what worked well for him did not necessarily work for me, and so a good deal of experimentation was required.


Hearing him explain how certain techniques could reduce complications in actual surgeries lent reality to the exercise. Indeed, several studies have found that achieving proficiency on surgical simulators is an effective way of improving surgical outcomes.1 However, I found working to improve my technique fascinating in its own right. On reflection, this probably had much to do with the feedback and discussions we had, which motivated me to keep improving my skill.


My experiences over those three months have completely changed how I think about surgery. Before, I thought of surgical procedures as highly goal-directed and straightforward – cut this, cauterise that, then remove that. Now, I’m fascinated that there is so much variation in terms of technique and so many ways to accomplish essentially the same objectives. If this continues, I may even have to start pursuing a career in surgery!



References

1. Dawe SR, Pena GN, Windsor JA, Broeders JAJL, Cregan PC, Hewett PJ, et al.. Systematic review of skills transfer after surgical simulation-based training. British Journal of Surgery 2014;101(9):1063–76.


About the Author

Jen Lim - SUTURE UK June Blog Competition Runner Up

Jen is a medical student at the University of Cambridge with an interest in the treatment and prevention of cancer