Importance of student mentorship in cardiothoracic surgery Denis Ajdarpasic

Importance of student mentorship in cardiothoracic surgery

Denis Ajdarpasic, Final Year Graduate Entry Medicine Student, University of Nottingham Medical School Mohammad Hawari, Consultant Thoracic Surgeon, Nottingham City Hospital

The traditional way of teaching aspiring surgeons has been “See One, Do One, Teach One”. However, with a limited number of surgical placements on the undergraduate curriculum, particularly during the pandemic, how does one begin the long journey of becoming a surgeon if we are not seeing, let alone doing or teaching?

Mentorship is one of way of improving access and diversity in surgery by giving mentors an opportunity to guide an aspiring surgeon through the long yet rewarding path that lies ahead. Competition for places will always be high (113 applicants for six places at ST1 selection in 2021), however, could we be doing more to attract students from under-represented backgrounds and make cardiothoracics appealing to a broad cohort of future surgeons?

My medical school (Nottingham) piloted a mentorship programme called FirstCut, which was 6 months in duration and partnered a medical student with a consultant surgeon from various specialties. The structure of the programme involved a minimum of three meetings with our mentors; an introductory meeting to discuss our objectives, a mid-programme review, and an end-of-programme sign-off to reflect on the programme as a whole.

I was fortunate to be given the opportunity to be mentored by Mr Mohammad Hawari in Thoracic Surgery at Nottingham City Hospital. We would like to share our experiences and recommendations on the importance of student mentorship in cardiothoracic surgery.

Mentee perspective Mentor perspective

Being on the same page as your mentor is crucial and I would advise medical students to be open and direct with their mentor so that you have a shared goal from the outset. During the first meeting I expressed my desire to gain hands on exposure in theatre and get involved with research projects. The pandemic was at its peak so both parties had to be flexible and realistic on what was achievable given the huge constraints. I would recommend you make the most of your other placements, even if they are not surgical in nature, as you will develop transferrable skills that you can bring into theatre. I was on an obstetrics and gynaecology placement at the time of our first meeting and got involved in a few c-sections where I was able to get the tactile feedback when performing a subcuticular closure that you cannot get from artificial skin pads.

It is important to mention that mentorship is not a one-way street. You get what you put in, and it is up to you to seek the opportunities and be persistent if you want the privilege of being part of the surgical team. Be flexible and have a long-term vision when it comes to developing your surgical skills. I started by doing closures and manoeuvring the thoracoscope, progressing onto opening incisions and port insertion/ set-up, to finally performing pleural biopsies and wedge resections over the course of the 6 months. I was also keen to get involved in a research project that culminated in a poster presentation at the British Thoracic Oncology Group annual meeting. Having said that, the one skill that I developed throughout this time was resilience. There is a realistic perspective you can only get when you are in theatre for the whole day, some cases may be more complicated than anticipated, maintaining focus at the beginning to ensure your opening incision is performed with adequate haemostasis, but also throughout the operation where the consultant will go through their reasoning for performing the operation in a certain way. Finally, all those long hours of practicing your skin closure and one-handed knot tying technique can be put into practice as you get the opportunity to close. Constructive feedback is crucial at every stage, regardless how well or not you may have done, always seek feedback on how you could improve next time. Mr Hawari and his registrars ensured that I was aware of how I was progressing and the aspects in my approach that needed improving. “The only difference between feedback and criticism is how you choose to hear it”, which is why I would also recommend a reflective diary. Choose the experiences where you learnt the most, irrespective of how you performed, to ensure these experiences stick in your mind and your future self will thank you for putting in the effort now.

Finally, in deciding if cardiothoracic surgery is for you, ask yourself: Can I see myself doing this job in years to come, and do the positive and negative aspects of the specialty suit my personality and plans outside of work?

I was intrigued by this mentorship programme as I benefited from having mentors during my training years and could see the value it may have for an aspiring surgeon. My approach was to gain an understanding of the prior experience Denis had alongside his aims for the programme. There were active and passive elements of this programme that I wanted Denis to be exposed to, such as the surgical decision-making process and how surgeons lead and work effectively within the wider team to ensure patients received the best outcomes. I also wanted him to Assisting and implement the lessons he learnt whilst observing complex cases with consultant performing parts of the operation and give teaching throughout him feedback and motivate him to keep improving and enjoy the added responsibility that came with “Being on the same page as increased exposure. Reflection is a crucial part of the process, your mentor is crucial and I my recommendation is to be proactive as a medical student, would advise medical students you will get opportunities if you put in the effort and be receptive to be open and direct with to the advice you receive. I would also recommend keeping their mentor so that you have a a log of all the operations you have been involved in. shared goal from the outset. ” Cardiothoracic surgery is a very demanding yet immensely rewarding profession.

Our recommendations

Based on our experiences we would recommend a similar approach by students wishing to explore the specialty and consultants with an interest in teaching and inspiring the next generation of cardiothoracic surgeons. The experiences gained during the programme provide value to both the mentor and mentee, and we would be happy to work with SCTS in implementing this on a larger scale. Finally, I would like to thank Mr Hawari and the team at City Hospital for making me feel welcome and part of the team from day one. This has been a fantastic learning opportunity that has enabled me to gain a realistic insight into the specialty whilst working in a dedicated and supportive team. n