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CSurgeries: An International Perspective with Dr. Juliana Bonilla-Velez

CSurgeries: An International Perspective

Dr. Juliana Bonilla-Velez

PGY 4 – Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences

 

Tell me a little bit about yourself.

My name is Juliana Bonilla-Velez, and I’m a 4th year resident at the University of Arkansas for Medical Sciences. I’m originally from Colombia, and that’s where I did my medical training. I was very fortunate to work with Dr. Rocco at Mass Eye & Ear Institute as a postdoctoral research fellow on oropharyngeal cancer, and then I came to do my residency training at UAMS. Here, I was also very fortunate to be able to work with Dr. Richter – who is not only one of the founders but an avid promoter of CSurgeries.

He introduced me to CSurgeries very early on in my training. It really is an amazing tool, especially for residents to be able to easily visualize all the things that you are reading!  At times, it can be difficult to put all the aspects of a surgery together (especially if you haven’t seen that type of surgery before) or to learn how different people [surgeons] do things. There are so many different techniques for each type of surgery, so I feel like it’s a great avenue that enriches resident education.

 

Dr. Bonilla-Velez, I understand you published with CSurgeries in June 2016.  What can you tell me about your experience? Was it easy? Difficult?

It was my first experience making a video, so that was a little challenging. I was working together with a medical student and we made a really good team.  She worked a bit more on the media aspect of helping to put the video together, but then we were able to work together and incorporate some of the more technical aspects of the surgery, and important steps and findings to highlight.

In fact, the recording of the procedure was not difficult at all. It did not interfere with the clinical aspect of what we were doing. The surgery went great, and recording did not obstruct it, make it slower or impose any impediment to the completion of the surgery. At the same time, it was very insightful to be able to review all of it and to put it together in a format that would be easy to teach others what was going on. Not only was it a great experience…it was fun!

 

It’s very interesting that as a resident you were able to partner with a medical student to take over the technical aspect of video recording and editing while you were able to oversee and supervise the surgical content. Having recently partnered with the International Association of Student Surgical Societies, it confirms that we’re going in the right direction. 

Absolutely. Even as a medical student, I was very involved in research and publication. I was actually one of the founders of the International Journal of Medical Students which was an amazing experience, but also gave me a better understanding of the other side of making science. From a medical student’s perspective, it is such an enriching and fulfilling experience to be able to participate in all of these avenues for publishing – participate in research projects, writing manuscripts or making videos – just learning how to think in that way, getting your feet wet and learning all of these skills are so important for the rest of your career as a physician, especially now with evidence-based medicine.

 

How has publishing with CSurgeries contributed to education as a surgical resident?

As an author, it was very interesting to be able to go through the process of putting the video together, thinking through all the technical aspects of what we were doing and summarizing it in a short format that would be easy to show others.

As a viewer and user of CSurgeries, it allows you to be able to see different techniques for different types of surgeries. Perhaps the Attending at your institution is doing the procedure one way, but seeing how others are doing it in other places certainly enriches your education. In preparation for surgery, CSurgeries publications allow you to see what the steps are, so you can get a more visual understanding of what it is you are going to be doing and what you’re reading in the books. In surgery, even more so than other specialties, this is critical. Learning in 2D in one thing.  Being able to see in 3D what it is you’re actually going to be seeing in surgery is quite another. For that reason, CSurgeries is definitely a very valuable tool – especially for people in training.

 

As a user of CSurgeries, is there a particular CSurgeries publication you recommend (either within or outside of your specialty) you recommend for our members to view and why?

As a 4th year resident, at least in my program, we haven’t started our otology rotation, so I feel like I struggle a little bit more trying to imagine and put together all the otologic surgeries. I haven’t been exposed to them nor have I seen them before. For that reason, one video that was very useful to me that I really enjoyed was Right Stapedotomy that was published by Dr. Babu at the Michigan Ear Institute. Just seeing the video, especially with the ear (it’s such intricate anatomy) was extremely useful. Having access to such a high-quality video that walks you through the surgery, seeing all the steps clearly, was really great.

Of course, there are going to be personal circumstances for which you would find a video more educational than others- depending on what your institution does or your prior experiences. One of the really neat things about CSurgeries is that there’s so much variety- not only within otolaryngology, but among all the other specialties. It’s got something for everyone.

 

You mentioned you are also a founder of the International Journal of Medical Students. What can you tell me about the IJMS?

Our vision was to create a space that would be made by medical students for medical students to promote research and to provide an avenue for publication that would include all specialties. We aim to speak to medical students who are in a unique part of their training. Not only do we offer a window for them to show their publications, but we are able to help get them to that high-quality level of having a paper that is amenable for publication.

It was also a very exciting to build a team of people that would be able to represent all  – not only from around the globe but also those in different stages of their training. We have mentors who have guided us from the beginning, taught us to put all these pieces together and to provide not only an avenue but a service for medical students worldwide where they can publish their work and learn. Especially nowadays where medicine is guided by the paradigm of Evidence-Based Medicine, it’s critical for physicians to be able not only to do research but to understand the research that is published. It serves to train both the authors and the students who are learning to be the editors about all the different aspects of the publication process.  It’s been a really very rewarding experience knowing we’ve been able to contribute to medical students’ education worldwide.

 

How is publishing with CSurgeries different from publishing with IJMS? How are they similar?

It’s different in the sense that the CSurgeries is a video peer-reviewed journal. It’s very visually perfect for the surgical field because it takes you through the novel of each surgery by  showing what the key structures are and the key steps you need to be doing. It’s very educational, especially for people in training. In terms of similarities, both aim to educate physicians, students and other surgeons. IJMS provides an avenue for written publication of research along with the more traditional strategies while CSurgeries provides an avenue for video publication. Both share a common mission of education.

 

What advice do you have for international medical graduates looking to pursue surgical residency in the United States?

It’s certainly a very difficult task, but at the same time, it can be immensely rewarding. You have to be very passionate about what you want to do, what you want to accomplish, and what you want for your life. If your goals are clear and you can translate all that passion into hard work and dedication to your specialty, that goes a long way. It’s certainly hard but not impossible. I’d highly encourage you to push through the difficulties if you feel that’s your life mission. Don’t give up on your dreams.

 

What would you be doing if you were not a surgeon?

Oh gosh! There is nothing else I would rather be doing! I wish I could have a parallel life to be able to do all the things I want to do, but all at the same time. But certainly the life I would not give up is being a future pediatric otolaryngologist and be able to continue to participate in academics, in research and education, and in clinical practice and leadership.  I look forward to playing a part in furthering the field.

Watch Dr. Juliana Bonilla-Velez’s video Excision of Thyroglossal Duct Cyst here.

CSurgeries Through the Eyes of a Future Surgeon

Akshay Krishnan
University of Arkansas Medical School, 2nd year

Congratulations to our GoPro Contest winner, Akshay Krishan!  As a medical student, he shares his personal experience with CSurgeries and the value it provides to fellow students who may be interested in pursuing a career in surgery.   

Tell me little bit about yourself.

I am currently a 2nd year medical student at UAMS. I received my undergraduate degree from the University of North Carolina at Chapel Hill, but decided to come back home for my medical training.

I was initially introduced to CSurgeries through a “Summer in Surgery” Program I completed through UAMS last summer—a one month program that was started by the General Surgery Department at the hospital. The goal of the program is to introduce students to General Surgery, recruit them to the field and introduce them to what General Surgery has to offer.  Through that program, I met Dr. Golinko. He gave me the opportunity to film one of the procedures (Fronto-Orbital Advancement and Cranial Vault Remodeling for Metopic Craniosynostosis) and publish to the site.

Were you always interested in surgery? Was surgery what you had in mind when you were accepted to medical school?

Yes. I’ve always been interested in surgery. Going into medical school, I was interested in orthopedic surgery. But completing the Summer in Surgery Program has broadened my view of the surgical field, so I am definitely interested in other areas as well. I’m excited to start my third year and get on the surgery rotation to see what else the field has to offer.

How has CSurgeries contributed to your education at UAMS?

CSurgeries has been beneficial. After I filmed the surgery with Dr. Golinko, he gave me free rein to do my own research, edit the video as I pleased, and add in the necessary content. In doing so, I got to do quite a bit of research on various medical topics that I had no experience with previously. I learned so much by doing this first-hand research and also developed a deeper appreciation for various medical concepts that I had learned in class.

How were you able to determine the surgical steps to focus on when putting together your video for peer-reviewed publication?

The procedure itself was between 7-8 hours. I didn’t film it in entirety, but I did film a good amount to make sure I got all the footage I would need later on.  Before I began distilling my footage down to the main components, I talked with Dr. Golinko and created an outline of the key points to focus my video on. From there, I did plenty of research and made sure to include/explain every key step in the craniosynostosis procedure.    

How long did it take to find that information and put it all together?

As a whole, the project did not take very long. Doing the research was pretty easy, so most of my time was spent going through all the footage and editing the clips to fit into the 5 minute limit.

How did you film the procedure?

For the majority of the surgery, I used one of Dr. Golinko’s cameras. For the last portion, I used my iPhone (Dr. Golinko’s camera had run out of memory).

What would you like to see CSurgeries do in the future? How can we help medical students who are interested in surgery?

I was introduced to CSurgeries through the Summer in Surgery Program. If medical students knew more about CSurgeries and knew that they could actively contribute to the site and get some publications for their own resumes, that would be extremely beneficial.

For those who are interested in the surgical field (or those who never really considered surgery as an option), giving them the opportunity to watch the videos on the site would be really beneficial. It can get more people involved in surgery and is also a great educational tool. Every medical student is going to have to go into their third year and do some kind of surgical rotation, so just watching some of the more common surgical procedures on the site would give students a basic understanding of the things they are going to see. Students would also gain a better appreciation of things the surgeon must do throughout each surgery.

Do medical students get any education in regards to video education in class and/or lecture?

I myself have not received any formal education on video education or projects. I wasn’t aware that video publications are a type of publication that is commonly used until I was introduced to CSurgeries.  

As far as video and teaching is concerned, our in-class lectures are recorded, so we can go back and re-watch things if we need to. Outside of that, a lot of the video educational tools we use are primarily geared towards Step 1 preparation.  

What advice would you give medical students who are thinking about surgical residency?

Surgical residency and the quality of life of surgeons have a reputation of being very difficult, time intensive and exhausting. While that’s all true, the positives of surgery need to be detailed to the students.  It’s honestly a very rewarding field to get into. Just by shadowing various surgeons and participating in the Summer in Surgery Program, I gained an appreciation of how these kinds of procedures really changed patients’ lives. Introducing medical students to the field and showing them the positives of surgery would be immensely beneficial both for them and the surgical field as a whole.

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The People Behind CSurgeries: Gresham Richter MD, FACS, FAAP


Meet Gresham Richter ─ Professor, Academic Surgeon and Co-founder of CSurgeries
(Better known as “G” to his colleagues at CSurgeries).

 

Q: How did CSurgeries get started? How did you come up with idea?

A: CSurgeries was originally developed to be an educational surgical outlet that was video based- to teach trainees how to perform the surgeries or  at least ask the appropriate questions during the procedure.  It was going to be a CD-based system, but then we realized we wanted to expand the market, not just for residents, but for everyone…students, patients and other surgeons alike.  We wanted to capture details for every field and do it on a grand scale, applicable to a bigger audience.

With this goal in mind, CSurgeries became a web-based venue.  To encourage publication, we wanted to make this a win-win for the surgeons taking the time to produce the video. Our answer was simple. Our “aha” moment, so to speak was… the videos submitted by our colleagues must be a peer reviewed publication where credit is given and the videos are validated.

Q: What can you tell me about CSurgeries that’s not on the website?

A: It’s an amazing site! It’s the perfect opportunity for surgical educators and anyone else trying to learn about a particular surgery or technique.  Surgical leaders from around the world are involved. There is so much activity already happening on CSurgeries.com.  Patients, students, and expert surgeons are exploring the posted peer-reviewed cases.

Q: What makes CSurgeries unique?

A: We are unique in so many ways, but really it’s the people behind CSurgeries team that make us unique. We are an academic physician owned and operated organization. Our mission as is to teach and we understand how to value video content for publication. We have brought in education leaders in each specialty who are hands-on ─ participating, editing, and overseeing the videos produced and published on the site. It has become clear also that those submitting are interested in authoring videos to teach, not just to have something on the internet.
We understand that in the area of academic surgery, publication is critical. We allow surgeons, and their trainees, to get academic credit for their high quality and annotated videos of procedures; each of our videos is peer –reviewed and as a result we are being recognized as the premier site for validating their procedures with a publication. In fact, each video that gets approved get assigned its own DOI publication number.  Companies like Research Gate already recognize our videos as a publication. Soon we head for PubMed and other Medline search engines…

Q: You are a surgeon. You are a teacher. You are an entrepreneur. Do you sleep?

Just enough. I have a very regimented schedule between family and work. Up early, home for dinner, kids to bed by 8pm and then I get right to work. Consistency helps. Family is critical. Thus sometimes I’m late to our late team conference calls!

Q: What advice would you give a medical student thinking about becoming a surgeon?

It’s a wonderful world and life…very rewarding.  More importantly, learn as much as you can by observing and operating as much as possible.

Q: What would you be doing, career-wise, if you didn’t become surgeon?

I actually went to med school to become a psychiatrist but I realized that I was simply not patient enough. Honestly, I think I would be in the business world one way or another. Fortunately, now I have a mix of both. Like they say they in Arkansas, sometimes a blind squirrel finds a nut.

Q: Where do you see surgical education headed…let’s say in the next 10-15 years?

Streaming education and no more books. On-line interactive education with video and chat. In this sense, surgical education is going to follow internet advances.

Have a question you would like to ask Dr. Richter? Feel free to post a comment or send him an email at gresham.richter@csurgeries.com