The Teaching Years

While I was focused on developing Pelviscopy after becoming the Associate Director of the OB/GYN Residency program at Methodist Hospital my basic duty was to train residents in Gynecology according to specific guide lines set by the Council on Resident Education for Obstetrics and Gynecology (CREOG). After taking the position, I made a commitment to teach in a way I had wanted to be taught early in my career and strive to be recognized by the students and residents as one of the best teacher they had encountered. I have always believed that it is a duty to pass on knowledge and my love for teaching was a payment on the debt to the special teachers I was privileged to have.
I had a 3 ring binder that I kept all of my lectures filed and tried to make the difficult easy and fun to learn, spicing them with colorful anecdotes and in surgery dropping “pearls” about techniques to make them better surgeons.
One of the things I first noticed after I started was when cases were presented either for staffing or at grand rounds, the residents lacked skill in how to properly present them succinctly. So I introduced how to format cases into the curriculum and I tried to teach some basic things and develop lectures that covered subjects in a way that was not threatening. And over the years I was awarded both “ The Best Teacher and Distinguished Professor Awards” which I treasurer as a measure of my teaching ability and value to the program.
I have always believed that learning is a continuum of life’s experiences, so I incorporated what I had gleaned from nurses, surgical techs, professors and
other l ancillary personnel to create a lesson plan I could follow that would take advantage of my knowledge to train my residents and medical students to the best of their abilities. I always repeated to myself what would I like to know and how would I liked to have been taught. This was my mantra for teaching!
I put together a course that I directed towards medical students that covered basic surgical skills, things that I had never been formally taught but had picked up. Things like how instruments came into use and how they worked ergonomically, why you use certain suture and the reason that specific knots are used for different tissue (i.e. surgeons knot vs a granny knot). I showed student in their junior clerkship these techniques so they would not feel awkward when asked to perform in the operating room as I once had.
Every time I gave a lecture, I always put it in a way that challenged me to teach as I was learning the subject for the first time. And I believe that my awards were in recognition for that passion for knowledge I passed along.
It should be stated that the OB/GYN Residency program was in a state of transition when I joined. With only 3 programs in the state it was in competition with IU and St. Vincent’s Hospital for candidates in the national resident matching system. IU
had 7 residents/yr, Methodist 4/yr and St. V’s 3/yr. It seemed that the top candidates 1st choice was Methodist especially those who had attended IU School of Medicine.
One of the unique things about the Methodist program was the vast clinical exposure that resident were getting because they were assisting attending physicians on their private cases and that they had their “own clinic” called the OB/GYN Care Center that was run like a private office. A concept that was put together by Dr Benson the program director.
In 1989 to evaluate the program, a retreat was held, the entire staff along with the residents met at a near by lodge to brain storm what were the program’s weaknesses, strengths and direction.
Because I believed that gynecologist in general were poorly trained in surgery, I suggested to the resident education committee that methods be instituted to enhance our residents exposure to surgery by having them rotate on general surgery in their intern year, having surgical techniques taught both by lecture and animal labs and doing a rotation where they were assigned to my service.
What I suggested was that since one of the duties in my job description was to perform all the Gyn surgery for Healthnet, it would be a clinical bonanza for the residents to be assigned to me as part of their Gyn service. At the time the OB/GYN Department had a contract to perform all the Gyn surgery for the Healthnet a community based agency that provided care for the indigent at 5 centers around the city of Indianapolis and performing the Gyn surgery was part of my duties. With a patient base of approximately 14,000 patients seen a year this provided a ideal clinical exposure.
When graduating medical student are applying for residency one of the question most asked during interviews is how much surgery will I be allowed to do. And it is known through out the country that some programs offer a stronger clinical base then others. We at Methodist were in position to use this as a strong recruiting tool. This became a favorite rotation.
I think it is important to understand that one of the most sought after services in a residency that deals with surgical procedures is to be in situations where you can be 1st assistant or primary surgeon. It was what the Healthnet service provided. The resident tagged with me in their 2nd and 3rd year and saw the patients in the clinic, assisted in making the diagnosis and scrubbed on the surgery with me as the attending surgeon. No resident could be bumped from a special case unless the chief on Gyn had never performed the surgery, in those cases the resident that worked up the case was the 1st assistant. This particular benefit went a long way in making our program attractive in the matching choices.
From my point of view it was a real stimulation to teach one on one residents who wanted to learn and have them over 2 years and see their cognitive and clinical skills reach fruition. They could wait to be on my service and it was basically a 24/7 rotation except when they had OB night call. Our day would start with rounds on postop patients, see patients at one of the Healthnet sites, see my private patients in my office and scrub with me on all surgeries 2 days a week in what was called block time. Also they had the opportunity to observe any technology or research project I was currently investigating. This gave them so much experience by the time they assumed chief resident, that they were more than willing to give up operative cases to a lower year colleague. When case lists of procedures were turned in each quarter for the Resident Review Committee our residents were far more experienced than most programs in the country. This was one of the things I was most proud of having put together towards resident education.
The Methodist OB/GYN Residency Dr Benson took over went from a scale of 5/10 to 9/10 based on the total opportunity to learn and turn out superior graduates. I was just part of a total package that included the Center Maternal Fetal Medicine and Genetic Diagnosis and Counseling, The Center for Reproduction and Transplant Immunology and the Center for Urogynecology and Pelvic FloorSurgery. These were heady times and we were getting our residents accepted in post graduate fellowships at some of the most prestigious programs in the country.
I was basically a gynecologic surgeon with a fascination for technology that was coming on line in medicine that complimented advanced laparoscopy and minimally invasive surgery. Things like Colposcopy, Hysteroscopy, Micro-surgery and the use of Lasers in Gynecology. All these technologies I learned and began teaching to others on our attending staff and surgeons in our surrounding referral base and to our residents. I was then appointed to the position Director of Gynecological Surgical Education.
I like to think that I had a meaningful impact on Methodist Hospital’s place in teaching and research in the time I spent as a member of the faculty.
But as in life nothing is static and in an attempt to adapt to a growing changes in hospital and medical education the hospital and resident education began to go in a different direction. Most of it I believe they would now reverse if given the option. The changes that evolved will be related in the story that follows.