By Meghan R. Lewis, MD, FACS
Meghan R. Lewis, MD, FACS, is the associate director of the surgical intensive care unit at Los Angeles County + USC Medical Center in Los Angeles. She also is an assistant professor of clinical surgery at the Keck School of Medicine of USC, and a critical care surgeon with Keck Medicine of USC.
LAC+USC is a Level One Trauma Center.
It has been a difficult time for our surgical residents. At a time when they most want to be honing the surgical skills that will be crucial for their future careers and patients, elective surgeries have rightly slowed to a halt to keep ICUs free for an influx of COVID-19 patients. At the same time, both Los Angeles County + USC Medical Center (LAC+USC) and Keck Hospital of USC are bracing for a wave of critical care patients that could overwhelm the system.
It was in discussing both dilemmas with chief residents, Dr. Dan Donoho and Dr. Chris Foran, that Dr. Stephen Sener, Chief of Surgery at LAC+USC, came up with a radical idea: Asking if surgery residents could augment our critical care nursing teams. We asked around and found one barrier: Surgical residents are trained only to play their typical role as a junior physician on a critical care team. Most of them do not know how to hang an IV bag and do not feel comfortable adjusting a ventilator. So, in partnership with the chief surgical residents, the Acute Care Surgery (ACS) Department of LAC+USC put together a curriculum to teach these vital critical care skills to our surgery residents. Within only a few days, the incredible team at the USC Surgical Skills Simulation and Education Center had arranged for a daylong workshop, held in small groups to adhere to coronavirus guidelines.
When we asked our surgical residents if any of them would be willing to sidestep their usual training in order to step into the front lines of the COVID-19 crisis, every single hand went up. I already knew that we had a class of resident surgeons who are at the top of their field academically, but I was moved to see how willing they were to risk their own safety to step in where our community needs them most.
The workshop was run, of course, by critical care nurses. One of the bright spots of this pandemic is seeing the world come to appreciate the fact that critical care nurses are a bulwark of the health care system. Nofal Kahwaji, RN, MSN, CCRN; and Ramona Paolim, RN, CCRN, from LAC+USC and Lt. Cmdr. Lorelie Flinn, RN, MSN, CCNS, CCRN, from the Navy Trauma Training Center, put our residents through the paces of blood draws, calibrating lines, titrating infusions, and other essential skills that keep a critical care unit functioning.
In addition to these skills sessions, the residents were given a crash-course review of critical care medicine. The ACS staff and fellows designed and taught an evidence-based curriculum on ventilator management and treatment of acute respiratory distress syndrome. This included a teleconference session and small group hands-on teaching modules.
This training has an immediate benefit to our community, but it also will benefit these surgical residents in the long run: They will have a working appreciation of what their nursing colleagues do, they have learned to think outside of their isolated spheres, and they will begin their future surgical careers poised to handle the next pandemic or major disaster. Each one will be able to pass their knowledge, adaptability and grit to a new generation of surgical residents.
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