Surgical Olympiad in Moscow

April 25, 2016 § 3 Comments

It’s been a little over a week since we returned from Moscow and I feel as though we’ve only just recovered. In the days that followed our return to Budapest, I think I slept almost 30 hours. It’s a good thing I got that sleep because with exam period only 3 weeks away, there is no time for rest!

The biggest hurdle ahead of us now is pharma. We have a midterm this week, the competition (for those who dare to attempt it) during the last week, and the final exam. Most of us want to get pharma out of the way in the first or second week of the exam period so we can “rest easier” with those that remain. The only problem is that there are nowhere near enough spots for everyone to do that. When we have registration next week (we haven’t been notified about the date yet), things are going to be crazy!

Pharma exam dates

Now, back to that trip to Moscow!

The Olympiad spanned four days: the first day for registration and training for the microvascular and tracheal intubation events and then three consecutive days of contests within different specialties. This being our first time, we had little idea of what to expect and hence, we decided to participate in all but two of the scheduled events. We later found out that most teams were divided into groups focusing on only one or two events, influenced by their desired future surgical specialty.

We were met at the airport by Prof. Dr. Sergei Dydykin, Head of Department of Regional Anatomy and Experimental Surgery of the 1st Moscow State Medical University, and 4th year medical student and representative of the university’s surgical club, Sergey Mindlin. From that point on, we were guided with the utmost care through our entire stay, including each and every step of the competition. In addition, we were supplied with all the requisite instruments and suturing materials we needed for the contests.IMG_5803

On the first day of the competition, we participated in the desmurgy, surgical knot-tying, tracheal intubation, gynecology, and microvascular repair contests. The day began with an Opening Ceremony where we were introduced to the members of the faculty and the 25 other teams participating in the Olympiad. Of all the teams, we were the smallest – by far! Most of the teams ranged between 10-20 students and some close to 30. While standing in the back and watching the ceremony take place, we noticed quite quickly that we were completely surrounded by students practicing knot-tying – and all of them averaging about 30-50 knots in only 30 seconds. It was at that moment that we realized what we were in for.

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All of of the contests included a case report, simulated clinical situation, lab/imaging findings, tasks and criteria. Various criteria were considering in grading each of the events (depending on the type and various components of the procedure), for example: aesthetics, stenosis, impermeability, teamwork/coordination, time to complete the procedure and theoretical knowledge of the case, and methods and materials used.

Here’s an example of the information we were given for the Abdominal Contest Amir and I did that Saturday.

Abdominal surgery contest

Clinical case: iatrogenic total hepatic duct intersection (before cystic duct joins it, type 1 Bismuth­Strasberg ) during laparoscopic cholecystectomy. 

Task: to reestablish integrity of gastrointestinal tract performing  Roux­en­Y type reconstruction (see fig.1). 

 Requirements

  1. Mobilize the intestine, ligating mesenteric arteries. Perform a stump in the end of the left intestine.  
  2. Perform a hepaticojejunoanastomy applying any preferred kind of hand suturing technique. 
  3. Perform an end­to­side jejunojejunostomy using any preferred kind of hand suturing technique. 
  4. Close defect of the mesentery. Screen Shot 2016-04-25 at 20.46.20Screen Shot 2016-04-25 at 20.42.02Screen Shot 2016-04-25 at 20.42.13Screen Shot 2016-04-25 at 20.42.28

Time given to complete the task: 70 minutes

  • Suture material provided: Vycril 4/0 ­2 packages, PDS 5/0 – 1 package, Nylon 6 (kapron) for ligatures. 
  • Surgical instruments ARE NOT PROVIDED. You are expected to use your own kit 
  • Usage of surgical staplers is forbidden. 
  • Team: 3 to 4 persons. 
  • Highest possible score – 30. 
  • The received points will be multiplied by a factor (f) according to the formula: f = 25/max points, f=0,833 
  • Material provided – ~ 6 cm long, 5­7 mm wide part of common bile duct, 45 cm long part of jejunum

Skjalg and Tamás represented us in the gynecology contest (where they received almost full marks) and the microvascular repair contest. For the gynecology contest they performed a laparoscopic salpingectomy on a pig uterus. The microvascular contest was divided into two parts: first, an end to side anastomosis on a chicken femoral artery and second, an end to side anastomosis on the iliac artery of a live rat.

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On the second day, Luca, Cintia and I took part in the endovideosurgical contest, Tiago in the trauma contest, and Skjalg and Amir in the coloproctology and cutaneous suture contests. The endovideosurgical portion also consisted of two parts: the first, a laparoscopic gastrostomy on a human stomach using one of two surgical methods (Depage-Janeway or Beck-Carrel-Jianu) and the second, a biliopancreatic bypass on a live, anesthetized pig. In the trauma contest, Tiago performed a four-core suture of an Achilles tendon – which was then tested with a 12-kg weight. Coloproctology consisted of an obstructive resection of a human sigmoid colon with creation of a double-barrel flat colostomy and the cutaneous suture contest of a necrectomy and Z-plasty.

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This was our third day in Moscow and the first day where we had time to actually see a bit of the city. On our list: Red Square!

On the third and final day, there were five total contests that took place simultaneously in one large dissection room. As a result, Cintia, Tiago, Amir and I were perform our urological and abdominal procedures at the same table, at the same time. For the urological contest, Cintia and Tiago performed an orthotopic neobladder procedure in which they made a bladder from a resection of the colon. For the abdominal contest, Amir and I were tasked with a Roux-en-y type reconstruction, which included a hepaticojejunoanastomy and end-to-side jejunojejunostomy, that we had to perform in a 15x15cm styrofoam box. While performing our tasks, we were approached by the judges as well as various students and faculty members who asked questions about our methods and decisions as to what material we’d used and why. It definitely added a whole new level of pressure and I was grateful to be at one table together as a team along with Dr. Székely, Dr. Juhos and our translator/guide Sergey, who was quick to aid us with absolutely anything we needed.

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Throughout the Olympiad we were approached by curious students wondering where we were from, why we chose to study in Hungary and how we ended up competing in Moscow. We’d organized Russian sim cards on our first day and we’re so grateful for the internet access when we found ourselves without a translator and needed google translate to carry on our conversations. It was such an amazing experience to meet fellow medical students and to share in our passion for surgery despite having such varied backgrounds. I was so struck by their drive and motivation and very humbled by the experience as a whole. We did better than expected considering that we’d only had a couple weeks of practice. The organizers of almost every one of the events remarked at how impressed they were with our efforts, especially upon hearing that it was our first time for some of the procedures. All of the students there showed a true love for surgery and the talent and drive necessary to go after it. Some of the teams had so much practice with each other that their procedures looked more like a choreographed dance than a surgical task. There was no need for them to speak because they already knew what the other was thinking and exactly what steps lay ahead.

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The Olympiad ended with a closing ceremony and an after-party at a club that they’d rented out. The ceremony was delayed for a few hours, so we went out for a bit to eat and then home to change and relax for a little bit.

Everything was in Russian (not a surprise by this point) so we weren’t really sure what was going on when the ceremony started. We soon figured out that they were giving awards for each of the events separately and then for the entire competition at the end. The surgery club of the university hosting the event (I.M. Szechenov 1st Moscow State Medical University) won the competition by a landslide. They were so, so impressive in every single one of the events. On top of their skill and preparation, they were in in charge of the Olympiad as a whole. They organized all of the events, invited all the judges, and obtained and prepared everything needed for the contests.

In one of the most heartwarming gestures of my life, we were called to stand in the front of the hall and introduced to everyone. They explained that it was our first time at this event and that it had been our first time attempting some of the procedures. Suddenly people started to stand up, first on the sides and then filling in to the center. It was such a surprise (as can be seen in my face in the first photo) and probably the most memorable part of the trip for me. It was such an amazing feeling to be honored in that way, to be honored and acknowledged for our strength and perseverance, for our venturing into the unknown. For that moment it felt like they’d pushed the competition part of it to the side and were just praising our shared passion.

The experience as a whole was something we will remember forever. It was an honor to represent Semmelweis, to attend as a team of Hungarian and International students, and to gain a glimpse into our futures. We were truly humbled and inspired by every step of the process and will use what we have learned to fuel us in our paths to becoming surgeons. We are so grateful for this opportunity, for the guidance, training and support we received from Dr. Székely and Dr. Juhos, and for the instrumental assistance and kindness of the students and faculty of I.M. Szechenov 1st Moscow State Medical University.

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T-minus 16 hours until Moscow

April 12, 2016 § 7 Comments

This past month or so has sped by faster than I ever could have imagined. With my study plan, my weeks are quite packed (I’m trying to do as much of my exam prep now as possible so that I can take my exams earlier). There have been several presentations and some exams on top of that. Plus an unforgettable 10-day trip to Thailand, followed by participating in the International Carnival at school (which required making 400 servings of cornbread and honey butter). And now: Moscow!

Preparing for this competition has been quite stressful – to say the least. Obtaining a visa, understanding the events, choosing the events to participate in, training for the events, etc. Sometimes I feel like my extracurriculars are twice that of my normal student load.

The competition lasts for four full days. We will be the first ever team to head there, so we’re both excited and nervous – we have absolutely no idea what to expect! For future years, the Department of Surgical Research and Techniques will most likely host an internal competition for those interested in going to to the competition in Moscow (Sechenov First Moscow State Medical University hosts an annual international surgery competition there). So, we are the pilot group!

This is the schedule for those four days:

 

We won’t be participating in all of them. For example, the cardiovascular one looked way too complicated and we wouldn’t have been able to practice it before. Also, there are a theoretical portion and instrument identification portion that are entirely in Russian. Now that I look at it, I think we are participating in all of the ones in the photos except for the cardiovascular and nerve repair teams. Pretty good for a team of only seven who have no idea what they are getting into ;).

After being in Thailand for 10 days and loving the chance to experience new places and a new culture, we’ve been trying to bring that energy back home to Budapest. How? By trying places we’ve never tried before! Sounds a bit silly, I know. But it is so easy to get caught in the same routine of places to go for drinks/dinner with friends, etc. After handing in the applications for our visas to Hello Oroszorzág, we grabbed some lunch at Menza in Liszt Ferenzc tér

Then it was off to plan our training schedule and decide which events we would want to take part in:

After that, we only had a week and a half or so of training ahead of us. We fit in four full training sessions:

Day 1: we tried our hand at intestinal anastomosis using pig intestine. It was so absolutely different from doing sutures on the skin! That is something that seems obvious, but it still surprises you when you are doing it.

Day 2: We worked on some cutaneous sutures, including a Z-plasty. The defect (“cancer” or “necrotic tissue”) is removed and two triangles are cut, switch places and are then sutured to close the hole made in the skin. My triangles weren’t a perfect fit, so my wound edges weren’t too clean, but it was still fun to try!

Day 3: We practiced gastrostomy methods for our “Endovideosurgical” contest. I did these sutures by hand during the practice, but we will do them laparoscopically at the competition. After, we spent a couple hours practicing our laparoscopic sutures in the pelvitrainer lab at school.

Day 4: All of us made our way to the training lab in Herceghalom. They are currently conducting a surgical residency training program there, but we were able to sneak in and use the pelvitrainers when they weren’t practicing on them.

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Here’s my snapchat video from the day. Please excuse my horrible spelling!

When Skjalg and I got home that night, we decided to try making our own pelvitrainer to practice with at home. It ended up being quite the success!

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It’s only the early evening now, but it’s time for me to pack and settle in for whatever sleep I can get. We leave for the airport at 3:00 in the morning and there probably won’t be too much time to rest in Moscow. A lot to do and a lot to see!! We have no idea what lies ahead of us but I am so, so excited. No matter what happens, this has been, is and will be an amazing experience :). I’m so thankful for this opportunity! I’m also really happy to get to know and work with some Hungarian students. It’s about time!
 

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