Surgery, OBGYN combine for new Global Surgery/OBGYN Rotation
August 26, 2021
Something felt different for General Surgery Resident Dr. Charles Liu as he unfolded the drapes and prepared to take part in a recent surgical procedure. He knew the instrument names and component technical skills, but this operation was new to him, and he was being closely supervised by an OBGYN resident and attending surgeon. Another major difference? The patient was pregnant, and the room was set up to welcome the arrival of a new baby by Cesarean delivery.
So, what was Liu even doing here? Why was a third-year general surgery resident receiving surgical training typically designed for housestaff in obstetrics and gynecology?
The Departments of General Surgery and Obstetrics and Gynecology (ObGyn) have combined resources to create a new elective rotation designed to give general surgeons the tools they need to provide life-saving obstetric and gynecologic surgical care in low-resource settings, both abroad and in the US. Liu is the first participant in this new curriculum.
“The intention of this program is to prepare general surgeons to practice in an international or rural setting,” said Dr. Rachel Seay, a Clinical Associate Professor in the Department of ObGyn and the Director of the Global Surgery/OBGYN elective. “If you're the only surgeon available, you may be called on to perform a cesarean delivery or other life-saving procedures like an emergency hysterectomy.”
A study published in The American Journal of Surgery last month indicated that a majority of general surgery residents in 2019 did not log cases “for procedures deemed important for global surgical care” including C-sections and uterine evacuations. The well-known international medical aid organization, Doctors Without Borders (MSF) requires all surgery applicants to have experience performing cesarean deliveries.
“I worked with MSF on several projects, and that experience informs our curriculum and several simulations of complex delivery scenarios,” said Seay. “Surgeons would tell me about needing to perform procedures they had only read about – to better prepare surgeons, we can simulate scenarios that are frequently encountered in low-resource environments. ”
During his rotation, Liu participated in two simulation sessions: an obstetric code blue (aka a cardiac arrest in a pregnant woman) sim led by Clinical Professor Dr. Kimberly Harney and a surgical skills simulation session reviewing obstetric skills in complex delivery techniques, uterine evacuation procedures, and surgical management of postpartum hemorrhage.
Additionally, Liu had the opportunity to practice and perform all of the obstetric procedures listed in the AJS article during his three-week rotation.
“I think my favorite part [of the rotation] was labor and delivery. Getting to deliver babies both by vaginal and Cesarean delivery was a wonderful experience, and very rewarding!” said Liu. “A dilation and evacuation wasn’t a skill I would have thought of learning, but it can be a life-saving procedure for a woman who’s had a miscarriage or pregnancy complication. I’m really thankful Dr. Seay planned the curriculum for me, as these were opportunities I would never have otherwise had.”
Prior to Seay joining the Stanford faculty in September 2020, several other general surgery residents had previously rotated with OBGYN, but the elective rotation curriculum had never been formalized.
Seay first became involved with Stanford Surgery’s Global Health Program four years ago while on the faculty at John Hopkins University. Dr. Sherry Wren was running a humanitarian surgery course at the American College of Surgeons annual Clinical Congress in Washington DC and was looking for Obstetricians in the area to help teach the course. Seay volunteered and a lasting connection was formed that ultimately led her to join the Stanford faculty.
“Some of the participating general surgery residents have previous experience working internationally, and some are preparing for that. We can individulize the curriculum for each resident based on what they anticipate their practice in a low-resource setting might be,” said Seay.
Liu lived in Uganda for eight months during medical school, although his experience at that time was primarily in research rather than patient care.
“I hope to do clinical work in resource-limited settings in the future, but I want to first finish my surgical training so that I can teach as well as provide care. Building capacity by training local providers has the chance to be more sustainable and impactful than just coming and doing a research project,” said Liu.
For Liu, an unexpected by-product of the rotation has been the chance to develop professional working relationship with Stanford OBGYN residents and attendings.
“I feel like we [general surgery residents] rarely cross paths or interact with them normally,” said Liu. “I hope I can bring some of the things I’ve learned and the best practices I’ve seen back to the surgery department and improve our collaborations moving forward.”
The Global Surgery/OBGYN elective is open to all general surgery residents in their third clinical year.