Surgery Competition: CHECK!

March 30, 2015 § 6 Comments

This semester we are taking the class Basic Surgical Techniques. In this class, we have been learning how to do proper sutures and in the upcoming weeks we will focus on building our laparoscopy skills (link to slides detailing the practicals: here). They offer two competitions, one each for suturing and laparoscopy. Only one person from each of the 18 groups gets to go to the competitions, so we must first compete against each other in our practical group to get the spot. Had Skjalg and I known that before, we might have chosen different surgery groups, since it is not very fun to compete against each other for something we both really want.

We have had three suturing practicals so far and in each of them, we’ve ended the class with a little competition. I placed in the first two, so had a good chance of going to the competition, but it all depended on how I performed in the last group competition this past Thursday. As I mentioned at the end of yesterday’s blog post, everything went wrong. For this last class competition, our substitute wanted us to do a simple continuous suture (the version seen at the bottom of this photo). fig-3-simple-continuous-suture-500x400I had been pretty nervous all class and it didn’t improve when the competition started. Then it got even worse. My thread broke three times, resulting in anything I had done being useless. I felt like giving up and accepting defeat, but decided to just keep going and do the best I could.

Once everyone else had finished, they began going around and placing their votes for the best sutures. When the points were tallied, it was another girl in the group who qualified as the top candidate for the surgery competition. She seemed so surprised when it was announced and then began to state that she really didn’t want to go and that she wanted me to go instead. By then the majority of our group had left and our substitute had left another teacher in charge. I had been washing my hands and really trying to convince the other girl that she should go if she wanted to and when I was about to leave, the teacher told me to stay. She shared that, before the substitute had left, the substitute had told her that I had had the best sutures during the practice (before the competition, of course) and that made it seem like I was the next candidate in line if this true winner didn’t want to go.  The winner assured us that she really didn’t want to go and when I was sure that she wasn’t just being kind, I accepted the spot by default. Afterwards, I was excited, but also a little disappointed. That wasn’t the way that I wanted to get the spot for the competition, but I forced myself to bury my pride and be happy.

It had been an extremely long day – and it wasn’t over yet! On Thursdays I have classes from 8:00 until 18:30. And with the microbio midterm that morning, I hadn’t slept more than 40 minutes the night before. Still, with the competition already the next day, I had to suck it up and push through. Once I got home after psychology that night, I took a short nap and then sat down to practice sutures for a couple of hours before bed. By midnight, I couldn’t see straight anymore and decided to call it a night and head to bed. The next morning, I sat for about 5 hours, making sure to go through all the sutures we’d learned and work on improving my speed with the most basic: simple interrupted suture.simple_interrupted1339023431202I did 6 or so rounds of 5-6 sutures and timed how long it took to do them. Afterwards, I graded their quality. For perfectly spaced sutures, I got my time down to 63 seconds (just divided the total time to finish all of the sutures by the number of sutures completed).

Skjalg and I have been practicing together before the practicals. We pick up pig feet from the market and surgical equipment from the store at school. It is also possible to practice on oranges or bananas, but I prefer the pig feet.

While practicing the night before:

Grading my timed sutures. These were my “perfect”ones. They’ve taught us the 1 cm rule in class and want us to follow that, even if it does seem like the sutures are quite big. They should be 1 cm from the wound edge, 1 cm apart from each other and the knot thread should be 1 cm. I was pretty happy with these ones – especially because I’ve had to train myself to be able to visualize how much a cm is! There is just no easy way to compare it to inches…

I was so nervous during my practicing at home that I was shaking for most of the morning. What ended up calming me was listening to Yann Tiersen’s Comptine d’un autre été l’après midi on repeat for almost the entire 5 hours. Moving my hands with the music and visualizing the suture thread running through the tissue together with the faster parts made the process almost artistic. There is an animation for this composition that makes me cry every time I watch it, in case you want to tap into some deep emotions on your end 😉

On the way to the competition, I ran into our friend Mads. He and I skirted around the topic of the competition and then finally admitted that we were both so nervous, but didn’t want to admit it to ourselves because then we wouldn’t be able to perform. Mads dubbed us “Team Zen” (we’re also, jokingly, Team Burnt Popcorn and Team Little Spoon).

The 18 of us attending the competition changed into scrubs and entered the practice room. We have been practicing on pig feet during the practices, but awaiting us were slabs of raw pork loin with the skin still attached. On the skin, there were marking of an X, a V, and a horizontal line. We were handed sheets on which to write our names and the drawings on it looked like Chinese to me. I couldn’t understand anything of the drawings – accept that this was going to be nothing like what we had practiced. I tried to re-create what the sheet looked like here:

FullSizeRender FullSizeRender-3The competition was split into two rounds. For the first round, we were to cut the shapes into the skin, separate the skin from the subcutaneous tissue (not entirely, just enough to complete the sutures), and then make the sutures as shown in the drawing. Now, in our practices, we’ve only ever practiced on a straight, horizontal cut. The most intimidating for me was the round suture at the angles: the corner stitch! None of us had ever heard of it and I started shaking at the idea of having to figure out how to do a suture I’d never done before. I later found out from a Hungarian TA that they didn’t learn the stitch until 5th year – and even then there was only a lecture and never something they actually practiced.

We were given a little tutorial about what they expected us to do and told us we were to memorize the instructions because they wouldn’t be repeated once the competition started. I was most looking forward to the simple horizontal line – until I learned that it wasn’t a simple horizontal line. There, we were to do a technique known as a Z-plasty, which is done to correct improperly healed scars:

This is more or less what we were looking at. The markings for round two weren’t added until we had finished round one.

FullSizeRender-2After an overwhelming tutorial, we were told that the competition would start and that we would have 15 minutes to complete the tasks! Only 15 minutes!

By the time 15 minutes rolled around, no one had finished. There was one girl who was able to finish right before 16 minutes, but the rest of us finished around 20-25 minutes. We were to be graded on time and quality, with quality counting for more points. As there were 18 of us, we would get points in that order, i.e. 1st person=18 points, 2nd person=17 points and so on. It was so unbelievably stressful that I almost couldn’t contain myself. The only thing I could focus on was the task at hand and I kept shaking so much that the thread often came loose from the needle. It wasn’t motivating either when those around started announcing they were finished.

After the 26th minute or so, those who had been unable to complete the tasks were disqualified. We had a 10 minute break, during which we nervously chatted out in the hallway, while the teachers went through and graded the quality of our sutures. The grades were based on dimensions, tension, placement, knot quality, etc.

When we were called back into the room, I fell into the back and hesitantly looked at the excel spread sheet projected onto the screen. I’d come in 3rd with 42 points and I was shocked. It had all gone so quickly that I had not had time at all to assess the quality of my sutures. If that doesn’t give any indication of the importance of practice, then I don’t know what does! With the time pressure and stress, the quality aspect needs to be a given.

The top 9 of us continued on to the next round (actually 10, since two tied for 9th place). The second round consisted on one difficult task: to remove two pieces of skin containing “moles”, switch their positions, and suture them back into place. There again was the dreaded corner stitch – and four of them to be exact! In addition to the suturing, we had to be sure to remove pieces that were the exact same size AND which met the criteria of having a 1:3 ratio (1 width to 3 length). I lost a lot of time while cutting out the pieces of skin, something I’d never practiced before. I was still on my first one when others had started suturing already.

We were given 20 minutes for the task and I think I finished in the 6th or 7th place. Waiting for the results was torturous.

When we were called back into the room, I could barely read the names projected on the screen. Not because it wasn’t clear, but because the past hour had been so unbelievably stressful. I started at the bottom and worked my way up. My name wasn’t anywhere. I blinked a few times, adjusted my position and tried again. There it was – and I couldn’t believe it: 3rd place! The winner had stolen 1st with a whopping 109 points, 2nd place with 100 and I with 99. The prizes for the competition are quite amazing:

  • 1st, 2nd, 3rd place: Grade 5 for the course – the entire course! Meaning we don’t have to take the final exam! (Which is HUGE, considering we have 8 exams.)
  • 4th, 5th, 6th place: Grade 4 for the course
  • 7th-18th place: exemption from the suturing portion of the final exam (plus, if any of them are selected for the laparoscopy competition, they are also exempt from the final exam with a 5 – regardless of their placement!)

When I went to congratulate Mads, who’d placed between 4th and 6th, he said, “Team Zen for the win!”.



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