I spent the fall semester of my junior year shadowing Dr. Richard Falcone, a pediatric trauma surgeon at Cincinnati Children's Hospital. I was able to observe him in the operating room, join him on rounds to assess pre and post-op patients, engage in training simulations with his team, and learn about his role as CCHMC's director of trauma services. This incredible opportunity was provided through UC's Professional Assessment and Learning center (PAL) while I took INT3041, an internship reflection course.
Every Thursday this semester, my day started early. I arrived at Cincinnati Children's around 7am, change into scrubs, and accompanied Dr. Falcone through whatever his day entailed. As the director of Pediatric Trauma Surgery at Children's, Dr. Falcones' day is quite varied. Some of the tasks I had the opportunity to observe include:
-operations ranging from appendectomies to tumor excisions
-pre and post-operative rounds
-speaking with the patients' family members after their surgery
-rounds in the neonatal intensive care unit (NICU) and intensive care unit (ICU)
-trauma response training using high fidelity simulators
-seminars about the field of trauma surgery and its current challenges
-morbidity and mortality conferences
In addition to getting a first-hand glimpse at the culture of pediatric surgery, I was able to observe the qualities which make Dr. Falcone an excellent leader of his department. I could tell that he is truly respected by all his colleagues -- including attendings, fellows, residents, and nurses -- because he leads at their level rather than from above. For instance, there was one morning where one of his residents was in a surgery which was taking longer than expected, and the resident didn't have enough time to get to their next surgery which was scheduled on Liberty campus. Although he was never asked, Dr. Falcone offered to call people and work out a new schedule so that the resident could focus on the surgery at-hand. Dr. Falcone seemed to have an genuine and open relationship with his co-attendings, residents, and fellows. I hope to apply his examples of servant leadership to any formal and informal leadership positions I will hold as I move up the medical hierarchy.
One parallel I was able to draw between my experience in translational research and Dr. Falcones' role as a surgeon is the importance of self-criticism. My research mentor constantly reminds me to be observant and prioritize a non-biased consideration of why an error might have occurred over the desire to avoid blame. He once pointed out that "hospitals employ protocols to prevent highly-trained professionals from cutting off the wrong leg". This means that, regardless of how experienced an individual is with a technique, there is always the possibility that they may enter into autopilot and make a mistake. In research, while these errors are annoying and may cost time and money, they rarely have a long-term impact on someone's life. An error made in the operating room, however, has the ability to cost a child's life.
Since surgery is one of the most high-risk specialties in medicine, protocols are in place to protect patients from mindless errors. For example, all instruments are counted before the first cut is made and when the surgery is complete to avoid the rare but still possible chance that an instrument could be left inside the patient. In addition, a "time-out" is performed before every surgery that occurs at Cincinnati Children's, during which the team pauses and confirms relevant information such as the patient's name and date of birth, the planned procedure, potential complications, and known allergies. In the same way that I have been trained to be critical of my research findings, surgeons must recognize their human tendency towards imperfection and do anything in their power to prevent errors.
My primary motivation for engaging in this internship was to gain a first-hand look at the culture of pediatric surgery. In shadowing several different specialties, I have found that they all have a different culture, and shadowing has given me the opportunity to discern which atmospheres I could see myself functioning within in the future. Overall, I liked the challenging intellectual-side of pediatric surgery, but couldn’t see devoting my career to the medicine-side of the field. Surgery is truly a field which dominates your life, and you have to really love what you are doing to thrive in it. For instance, Dr. Falcone works around sixty hour weeks when he isn’t on-call, and when he’s on-call he works 24+ hours straight. Surgical residents work closer to 80 hour weeks with more frequent on-call days, which leaves little personal time or time with family. Dr. Falcone’s current schedule is closer to the hours I want my medical career to entail, but I realize that he spent seven years as a surgical resident, along with additional fellowship and master’s degree training time, in order to get that schedule.
Therefore, while I found that I enjoy the challenging, forward-thinking culture of surgery, I don’t enjoy the science enough to be happy with a work-life balance which is considerably less than other specialties. I do know, however, that I enjoy the culture and patient-population of Cincinnati Children’s, so my goal is practice as a pediatric hematologist-oncologist in the future. This will allow me to merge my interests in research and pediatric medicine while still maintaining somewhat of a work-life balance.
Much of this reflection includes excerpts from the blog I maintained during the internship, which can be found at noralakespal.weebly.com