Filed Under:

What Clementines Can Teach Surgeons

Play associated audio

Clementines and pelvic anatomy are two things you probably wouldn't ever talk about in the same sentence, unless you're Pamela Andreatta.

Andreatta, a medical educator at the University of Michigan Medical School, knows all about how people learn. And lately, she's been spending a lot of time scrutinizing how residents are taught to do minimally invasive surgery.

In particular, she's been looking at how doctors master laparoscopic surgery, performed with a camera and surgical instruments inserted through tiny incisions in the body.

"We can do better — much better," she says.

The traditional apprentice model of learning by watching then doing is putting young doctors in operating rooms before they've mastered basic skills, she says.

And while there are surgical simulators on the market, including high-tech digital systems offering a virtual reality, she believes the skills crucial to laparoscopic surgery might be better taught with something as simple as a clementine.

The idea came to Andreatta after a colleague in gynecologic oncology asked whether she could come up with a simulation to teach the delicate task of removing lymph nodes, something done to minimize the spread of cancer.

She considered the fact that throughout the pelvic anatomy, there is a mix of substantial and delicate tissue. And then she thought about a clementine. It has a sturdy outer peel, but also the more fragile pith, the white spongy layer under the skin.

Andreatta set up an exercise using an opaque box with holes in the top through which you can insert a camera, scissors and grasper. She invited residents, medical students and faculty to dissect clementines.

They had to take off the peel in as few pieces as possible, remove the pith, separate the segments, then put everything back together and suture the peel closed. They had two hours to complete the task.

Andreatta designed a complex scoring system, which took into consideration the finished state of the fruit, each person's planning and clinical judgment, plus some other factors.

In all, 41 people dissected clementines. The minimally invasive surgery specialists scored the highest, by far. Residents and nonsurgical faculty scored significantly lower. Medical students, with little or no surgical experience, fared worst.

The results, Andreatta says, confirm that the clementine is a suitable model for training. Faculty surgeons backed up that assertion, remarking on the similarities between the simulation and actual surgery.

The clementine is in fact just one of several dozen low-cost simulations Andreatta has developed for teaching minimally invasive surgery. Another uses colorful foam shapes purchased from a craft store.

Her hope is that at the University of Michigan and elsewhere, the training boxes, clementines and foam pieces can be placed in offices and hospital call rooms, so that residents and faculty can practice whenever a free moment arises.

Moreover, Andreatta says, these models can work just about anywhere. Already, she's taken them to Ghana, where the University of Michigan supports a laparoscopic surgery training center.

"You can find clementines or setsumas or tangerine variations all over the world," Andreatta says. "You can go out and pick them off a tree, and it costs very little or nothing... and yet it's very advanced training."

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

NPR

For A Female Banker At The Top Of Her Game, What Does It Take To Stay There?

In the film Equity, investment banker Naomi Bishop navigates the male-dominated world of Wall Street. Screenwriter Amy Fox discusses the film and her research, which included many interviews with women who worked on Wall Street.
NPR

Salvage Supperclub: A High-End Dinner In A Dumpster To Fight Food Waste

The ingredients — think wilted basil, bruised plums, garbanzo bean water — sound less than appetizing. Whipped together, they're a tasty meal that show how home cooks can use often-tossed foods.
NPR

LISTEN: At The DNC, We Asked Women Why They Were Voting For Clinton

We asked women — as young as 4 and as old as 77 — how much the weight of history factored into their decision.
NPR

Hackers Break Into Another Democratic Party Computer System

The DNC's congressional campaign arm is the latest hacking victim. Investigators say the breach is similar to other recent incidents and that they believe Russia is the likely culprit.

Leave a Comment

Help keep the conversation civil. Please refer to our Terms of Use and Code of Conduct before posting your comments.