The Art and Science of Touch

Recently one of our own Women Surgeons, Dr. Carla Pugh, was an invited speaker at the popular TEDMED 2014 event.  In the session “Play is not a waste of time,” Dr. Pugh discussed Haptic Learning – the Art and Science of Touch – and her own experience with integrating this concept in surgical education.

Dr. Pugh started her talk with a powerful recollection of a difficult procedure in the emergency room – a thoracotomy. Dr. Pugh noted something made her seriously worried: the resident working with her seemed to have missed a critical finding while leading the thoracotomy, cardiac massage, and evaluation of the patient.

“As a surgical educator I am worried why my resident missed the blood clot around the heart, and things were moving so quickly that there was no time to discuss this great learning opportunity.”

I had the opportunity to interview Dr. Pugh to discuss her TEDMED talk and more.

In regards to the education opportunity that was missed with the resident, Dr. Pugh notes that providing feedback to residents is not built into the system. “The goal is to take care of patients & make money... Nobody gets paid to teach. Feedback is not built into the system... People who enjoy teaching do it, but it is not well-integrated. How do you teach residents how to be assertive? How to learn points of the operation? This is something that happens every day in medicine."

Unfortunately, Dr. Pugh has noted that this is something that has not changed since even her days in surgical residency. Despite high expectations, she notes that it is rare for people to provide direct detailed information/feedback.

This is how she got into Haptics.

Dr. Pugh holds a patent to a sensorized clinical exam model. She landed her first patent in 1998 during her postgraduate studies at Stanford University. The models can sense aspects of the physical exam such as tactile technique. One exciting finding to be published soon, was a model adapted for the clinical breast exam (CBE).

Dr. Pugh’s team was collecting data on CBE from experienced clinicians to help identify which technique was most sensitive to detect a mass in the breast. The data was supposed to help teach medical students the appropriate technique for CBE. A surprise finding was that 10-15% of clinicians were missing the mass in the model! Upon review of the data from her sensorized model, it was found that a specific examination technique was associated with being more likely to miss the mass. 

Dr. Pugh notes, "We must go beyond the paper and pencil test." The technology is now available to help assess clinical exam and surgical skills. Incorporating this type of feedback into medical education and continuing medical education will likely make a big difference for patients.

Dr. Pugh grew up in Berkeley, California, and has long been interested in science and medicine. At 5 years old she received her first stethoscope and "was listening to people's ankles at the grocery store." As a child she had her first run-in with the power of touch “I was always taking things apart,” she notes. It was during one of these play sessions in the living room, she was electrocuted at 5 years old. “My hand was stiff!”

How do I get involved?

Dr. Pugh has an active research lab, which usually consists of engineering students. She has had two residents working in her lab. In addition to traditional surgical meetings, Dr. Pugh attends conferences usually dominated by engineers, like NEXTMED where Medicine Meets Virtual Reality.

Thank you, Dr. Pugh, for reminding us to dream big and never forget the art and science of touch.

Minerva A. Romero Arenas, MD, MPH is a General Surgery Resident at Sinai Hospital of Baltimore. She recently completed a research fellowship in the Dept. of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX.  She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate. 

Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.

She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.

Networking = Connectivity

by: Sharon Stein, MD, FACS

To me, networking is all about connectivity. It is about finding people with whom I have something in common and forming bonds. Sometimes it gives me opportunities, sometimes it allows me to connect colleagues, and sometimes it allows me to help someone out. But it is focused on having a network of people who I feel comfortable talking to, learning from, and asking help from. 

There are tons of places to network. I see networking opportunities in meeting patients, in speaking to referring physicians, and at work cocktail parties. I also see opportunities at my daughter’s school, at the grocery store, pretty much anywhere. Don’t think about networking just in terms of fellow physicians, power players. The wife of colleague might be the one to put a bug in someone’s ear and provide a great opportunity.

I never go into a networking opportunity with an agenda. I look for interesting new people that I enjoy speaking with and have something in common with. In fact, networking “how to lists” say look for opportunities to help others. If I can help someone finish a project, find a mentor, point out a job opportunity, it creates great bonds, which are often reciprocated.

Most networking lists say take business cards, add them to your phone and follow up with an email. One of my colleagues goes one step further. She always writes down the names and information about the family members of people she meets. The next time she sees a colleague she can ask how Junior’s tennis match went, or how her daughter’s wedding was. When she meets that new person again, they feel a personal connection because she remembered. I thought this was a great idea and it has worked well.

For me, Association of Women Surgeons has been a great place to network. For starters, we all have something in common – we are female surgeons trying to make our way in the world of surgery. In general, we tend to be doers, interesting people, and motivated by our jobs. Although I can bond with surgeons at ACS, and other surgical society meetings, the large group setting can be intimating. The smaller setting of AWS has provided me with the courage to approach senior surgeons, I wouldn’t otherwise have access to. This has been a great way to meet some of my role models. Prior to introducing myself, I practiced my opening, who I am, what I wanted to discuss with them. To take things a step further, I volunteered and have participated in committee work. This brought me into even smaller group situations working for a common goal. Just last year, I met someone at AWS who took the time to introduce herself to me. Now we have worked on a number of projects, very successfully and it has turned into a great opportunity for both of us to advance our professional goals.  

Networking is about making friends, just like in high school. It’s easy to be intimated by the group of cool kids sitting at the lunch table. But now that we are grown ups, I have found that my role models and colleagues are really open to talking to me. Even if I am tired at the end of a day of conference, I always try to go to the social event and speak with one new person. You never know when those new contacts will turn into a great opportunity, or a great new friendship. When I look back at people who have assisted me with creating opportunities, some of them had formal relationships, people I worked with. Just as frequently, they are folks who I met in casual settings, maintained a relationship with, and now have become friends and supporters of my career. 

Come network with me at AWS Conference…I’ll look forward to meeting you.

Here are some resources for networking. 

• http://passivepanda.com/networking-tips
• http://www.forbes.com/sites/theyec/2014/07/28/how-to-network-the-right-way-eight-tips/
• http://www.businessinsider.com/how-women-can-network-more-effectively-2013-11 

--------------------------------------------------------------------------------------------------

Sharon L. Stein is an Associate Professor in the Department of Surgery at University Hospitals/Case Medical Center in Cleveland Ohio.  She is a member of the division of Colon and Rectal Surgery. She serves as associate program director and surgical director of the inflammatory bowel disease center.  She did her training in general surgery at Massachusetts General Hospital and fellowship at NewYork Presbyterian Hospitals Cornell and Columbia.