Our students avail of elective opportunities at home and abroad. These electives allow students to explore in further depth topics of relevance to their degree programme. As part of our summer elective series, medicine student Anthony Cullen reflects on his time at Washington University, St Louis during summer 2011.
Last summer (2011) I spent four busy weeks attached to the Abdominal Organ Transplant team at Barnes-Jewish, the main teaching hospital of Washington University in St Louis School of Medicine. Barnes-Jewish is one of the top ten transplant centers in the United States by volume and last year performed 412 solid organ transplants.
My team consisted of five attending surgeons, including the chief of abdominal transplant surgery, two transplant fellows, a resident, an intern and a second medical student. My first full day began with fellow-led rounds at 6am at which the medical students were expected to write up and file the patient’s progress notes.
As the rotation went on I was expected to follow patients whose cases I had attended in surgery. This required me to come in earlier to pre-round on those patients and have a SOAP note (subjective, objective, assessment, plan) ready to present at rounds. After rounds I then completed any necessary ward work such as a removing central lines and Jackson-Pratt drains.
Once I was finished with morning wards I went to the OR and divided up the daily list with the other medical student. The OR always had a range of hepatobiliary cases such as Whipple procedures and liver resections, along with procedures for those patients on dialysis such as arteriovenous fistula creation or peritoneal catheter placements. The general atmosphere in the OR was outstanding and it was often great fun to work there.
The Attendings, fellows and residents were all keen to teach, as were the anesthetists and the OR nurses, and they made me feel very welcome. They spent considerable time developing my basic surgery skills, such as suturing and tying. As time went on I was allowed greater participation in cases from retracting, to closing the abdominal cavity, to performing certain procedures such as cholecystectomies. As students we were also expected to accompany the patients to and from the OR and to help out with any preparations for surgery.
In addition to the regular OR list we were always waiting for a transplant to be scheduled. I usually alternated with the other medical student between attending the donor organ procurements and participating in the actual transplant, but on some occasions I was there for both which usually meant very little sleep that night.
The organ procurements were particularly memorable as they often involved flying in a private jet in the middle of the night to other cities in the mid-west and being scrubbed in alongside Attendings from other hospitals, such as cardiothoracic surgeons who had also flown in to procure the heart and lungs. The donor and transplant procedures are particularly good surgeries to be involved in from a student’s perspective as the large open incisions and the removal of the organs allow excellent teaching opportunities.
After the OR cases, a normal day would involve rounding with the Attendings in the Intensive Care Unit and the main wards. I was expected to attend meetings where patient cases would be assessed for transplant suitability and also attend the weekly morbidity and mortality conferences for the surgical department.
At the end of my elective I was required to prepare a presentation for the team on a topic of interest from the rotation, in my case it was on the implications and management of post-transplant diabetes mellitus in renal transplant recipients.
I would recommend this elective to anyone who has an interest in surgery as you will get ample OR time. As each case will generally just have an Attending plus one fellow or resident scrubbed in you will also get plenty of opportunity to participate. In four weeks I was scrubbed into seven liver transplants, six renal and one pancreas transplant, along with numerous hepatobiliary cases.
By spending the full four week elective attached to the same team you will get to follow every aspect of patient care in depth. This elective does require a considerable time commitment but you will get so much out of the experience that it is well worth it.
Overall it was an amazing elective and I would like to thank the Muiris X Fitzgerald scholarship fund, UCD School of Medicine and the surgical team at Barnes-Jewish hospital for facilitating this experience.
About the Muiris X. FitzGerald Scholarship:
Two scholarships in honour of distinguished clinical researcher and former Dean of Medicine are provided by the UCD School of Medicine & Medical Science. These support one student selected elective in North America and one student selected elective in the Developing World. Each student will receive a stipend to help cover their travel and other expenses (sponsored by the John Henry Newman Foundation).