• Uniformed Services University Hosts ‘Boot Camp’ for Prospective Surgeons

    A close up shot of Navy Lt. (Dr.) Yarrow Sheldon practices her suturing skills.
    By Sharon Holland

    They didn’t have to stand in formation or run through muddy obstacle courses while drill sergeants barked orders in their faces, but seven senior medical students from the F. Edward Hebert School of Medicine at the Uniformed Services University (USU) spent four arduous weeks going through their own grueling boot camp.

    The students, Navy Ensigns Utsav Patwardhan, Elise Sienicki, Mathew Christian, Yarrow Sheldon, and Alexander Kersey, along with Army Second Lieutenants Nathan Bastien and Brook Pari, were all headed to military surgical residency programs following graduation from medical school. Faculty from the USU-Walter Reed National Military Medical Center (WRNMMC) Department of Surgery, the USU anatomy and radiology departments, along with surgical residents from WRNMMC, conducted the Surgery Boot Camp to provide the students with the knowledge and technical skills necessary to be immediately successful as they begin their post-graduate surgery training.

    The boot camp was the brainchild of Army Col. (Dr.) Frederick Lough, deputy chair of the
    USU-WRNMMC surgery department.

    “The day before medical students graduate they are filled with knowledge and have no patient responsibilities. The day after they graduate, they realize they will soon have patient responsibilities and they have limited knowledge and skill,” Lough said. “While they have witnessed and have learned basic surgical tasks, it may have been months since they were required to actually perform a task such as inserting a foley catheter. The Surgery Boot Camp course was created to provide focused training in surgical skills and surgical knowledge before they begin their post-graduate training.”

    The month-long course was developed to review critical surgical anatomy and radiographic information, to review Advanced Trauma Life Support (ATLS), how to be successful as a surgical resident, operating room conduct, pre-operative and post-operative orders, working on surgical wards, dealing with night calls, dealing with angry families, deployments, self-care and other topics.

    Surgery instructor Ed Jones (right) observes as Navy Lt. (Dr.) Yarrow Sheldon practices her suturing skills
    Uniformed Services University (USU) surgery instructor Ed Jones (right) observes
    as Navy Lt. (Dr.) Yarrow Sheldon (left) practices her suturing skills.  Lt. Sheldon
    participated in USU’s Surgery Boot Camp just prior to her graduation from the
    university’s F. Edward Hebert School of Medicine. 
    (Image Credit: Sharon Holland)
    Lough was assisted by USU faculty members Ed Jones, an instructor in the surgery department, Dr.
    Alan Seyfer, professor of Anatomy, Air Force radiology faculty members Col. (Dr.) Ellen Chung and Lt.Col. (Dr.) John Lichtenberger, trauma surgeon Dr. Mark Bowyer, and fourth-year Navy surgical residents Lt. Zachary Taylor and Lt. Kathryn Wolf.

    The first week students had a crash course in anatomy. From there, they moved on to a review of surgical instruments, knot tying, where to stand in an operating room, patient positioning, prep and draping of patients, foley insertion, video scope tower preparation, pre- and post-operative orders, discharge summaries, ordering blood products, operative consent, the wound vacuum-assisted closure (VAC) system, and, especially relevant for military surgeons, the PUHLES system. The PULHES system is a physical profile system, which stands for Physical Capacity/Stamina, Upper Body, Lower Body, Hearing, Eyes, and Stability/Psychiatric. Students also did a complete review of ATLS, and central line placement.

    In the last two weeks, the soon-to-be surgeons did an American Board of Surgery In-Training review, and covered surgical sign–out, nutrition, conducted a stent lab, reviewed chest tube placement and removal, nursing calls, deep vein thrombosis, electrocardiogram reading, and interpreting arterial blood gases, dealing with myocardial infarctions, bleeding, pulmonary embolus, tachycardia and atrial fibrillation. They reviewed wound VAC placement and removal, and troubleshooting ostomies. Students concluded the boot camp with radiographic review -- chest x-ray, computed tomography (CT) and magnetic resonance imaging (MRI) – along with an overview of operational medicine, deployment and self-care.

    “There is a definite need for graduating medical students to ‘top off’ their knowledge and skills before they begin their graduate medical training. This unique course provided the opportunity for our students to have a focused and concentrated experience to fine tune the skills they acquired over four years at USU. This will allow our graduates to be more effective and confident as they begin the next phase of their training as military surgeons,” said Lough. “We plan to follow up with them to see how we can improve our course. It is recommended that this course be expanded and formalized in the elective schedule. Rising fourth-year students have already asked to participate in next year’s course and surgical residents have been selected to teach.”

    “The Surgery boot camp was a really rich experience, put together by USU-Walter Reed faculty and two Walter Reed residents, based on what they thought would be most important for us to know. While it's hard to choose the single best session, I think my favorite was practicing the various overnight ‘nursing calls’ that we could get for our patients, knowing what steps to take and when to call for help. I expect to be in many of those situations in the near future, and going over those scenarios will undoubtedly have been very beneficial,” said Padwardhan. “It was a good warm-up to get into the surgical mindset. I really hope that they can expand the program for more students next year.”
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