Springfield

I had an outstandingly rewarding visit to Southern Illinois University(SIU), greeted warmly by Reed Williams and taken to my hotel, the Abraham Lincoln. Springfield is the birth pace of one of America’s most loved presidents and you cannot move more than ten yards without being reminded of this!

We had a very pleasant dinner in the country club, with Gary Dunnington, clearly the boss, Debra Klamen a charming psychiatrist in charge of teaching in the medical school, Stephanie Donnelly a trauma surgeon and an education fellow from the Mayo Clinic, David Rogers a paediatric surgeon with a special interest in teaching and Reed. Reed is a quiet man with a PhD in education who has an attachment to the surgical division, he fulfils the same sort of role as Debra de Rosa in Northwestern.

The next day dawned early (or so I thought, the American is industrious and Gary Dunnington started his elective operating in a private hospital at 7.15am. I was collected at 8.00 by Reed and taken to the Memorial Hospital. This is a six hundred bedded institution, which together with one other hospital in town serves Southern Illinois, from Chicago 200 miles to the north to St Louis, Missouri, 90 miles to the south. In the energetic style characteristic of the American, they have attracted senior staff from all over the country to help deliver their programme of training and service to their population.

I went to meet the Associate Dean, Debra Klamen who greeted me in her well equipped office (all the Americans I have met on this trip have had large offices, with conference tables). We discussed various things, including their problem based learning curriculum, widely used in N America as in many UK medical schools. At SIU, they have hybridised their PBL (one of the purposes of this trip was to pick up the jargon) with a structured teaching course that followed. I asked how she would incorporate changes into the curriculum, for example an increase in anatomical teaching. She said any changes had to be supported by data.

Then I went to the skills lab, where half a dozen medical students were doing a course in preparing them for surgical residency. This was a series of classes over a month which incorporated skills teaching and practice. They opened abdomens and made surgical airways. These were all done with a series of highly inventive low tech models, devised by the two theatre nurses who had been recruited to run the centre, Janet and Jenny. This was inspirational, because it showed how with enthusiasm, a space and dedicated personnel skill teaching could be achieved without massive capital investment. They did have a simulator but it was “down”.

After a further meeting with Reed examining the extent of the academic output of the department, I returned to the lab later and was taken through all the manuals and shown several of the models they had made. I was able to share with them the Leong and Aldren model of the artificial ear drum.

I then gave a short presentation on the state of surgical training in the UK. They are very courteous and listened with patience. We then explored how they manage their programme, and really the biggest unanswered question is how effective the skills training is. There is some evidence that it helps to identify completely unsuitable trainees and it speeds up the rate of skills acquisition

Then I met with Gary privately, in another large office. Like many surgeons he is adriven man but has created a really outstanding tertiary referral unit in “the sticks”. By his devotion to education he has brought alongside him a team of committed and likeminded individuals. Their commitment is shown by the fact that they all put 5% of their income into a communal pot and this is then divided amongst those who have put them most into education, measured by the credits that they have earned for academic activity.

Then I met the nurse educators. Margaret Boehler, and Cathy Schwind and had an inspiring hour with them. They coordinate all the training, provide support for the ready for residency programme and generally provide the glue which keeps surgical training going. They were both charming enthusiasts and believed in what they were doing.

Finally I met with Stephanie and Lesley, two research fellows in the department. Stephanie is a surgeon from the Mayo clinic and has come to evaluate the place of skills training in the training of young surgeons and Lesley a second year resident who is undertaking a masters in surgical education and has been inspired to follow in the footsteps of the medical educators that she has come across. They very kindly thought it would be good to meet off site and they took me to a quaint tea house, rambling like an un-restored 19 century vicarage in a once prosperous suburb. There were whole rack of delectable cakes and tarts, the American has an unashamedly youthful taste, and we all tucked in. They, my hosts, were lovely. They like all the other young surgeons I have met were uncomplicated in their love of their work. The resident in America earns a stipend of $30,000, less than a nurse. In m any towns they have to live in rented accommodation, though in Springfield they can buy a one bedroomed condo for as little as $50,000, and the average house price is twice that. They all have large debts at the end of their training which can take years to clear and yet they still want to be doctors!

Well what are the take home messages? The first is that any project needs clear sighted and charismatic leadership, problems can be solved in innovative ways, programmes do not just need doctors to deliver them, good ideas come from anyone and to work towards something of which you are proud will probably enhance patient care.