Molly Craig ’21

Brigham and Women’s Hospital, Boston, MA

I was quite nervous before I started my internship with Dr. Smink at Brigham and Women’s Hospital. I think part of the nerves rose from my inexperience with both the field of surgery and urban healthcare. I grew up in a rural town in Pennsylvania with a population of about 3,000 and I had to drive 20 miles to get to a small-town pediatrician. My previous internship was in rural Appalachia working at a local clinic who serviced mainly a homeless population. So, I not only had to figure out how the heck public transportation worked, but I also had to enter into one of the best hospitals in America whose inner and outer environment embodied a foreignness akin to a new pathogen entering a healthy body. I think the other half of my nerves arose from my pre-conceived notions that the surgical field and surgeons, in general, were colder, robotic geniuses with larger egos than the average healthcare professional. I was worried that my initial intimidation of this new situation would be as obvious as blood-red marker across my forehead reading “SHE IS NOT CUT OUT FOR THIS.” However, I am so thankful that I was proved absolutely wrong.

On the first day of my internship, Dr. Smink took the time to show me around the hospital and immediately established projects I could start working on, meetings I could attend, and people who I could meet. He was kind, patient, and made me feel listened to; this was the exact opposite of what I had expected to happen (cold, rushed, and dismissive). Dr. Smink’s specialty is in minimally invasive general surgery which includes things like abdominal wall hernias and foregut surgery. Routinely, I would come to his clinic and be able to observe how he diagnosed and interacted with new and old patients alike. I especially loved these days because I would walk in and he would hand me an official Brigham’s doctor coat to wear for the appointments with patients that day (so I would look more official). Every time I put it on it made me more excited and driven to actually obtain the iconic white coat one day, except one with my name stitched into it like his. As patient and open to listening Dr. Smink was with me, he was a hundred times these qualities with patients. I have been in so many doctors’ offices where it feels like a cattle-herd—get in, get out as fast as possible. I learned that this does not have to be the norm. I learned how to interact with patients in ways that are clear, concise, but yet extremely empathetic and authentic for the future. This will always be an invaluable gift to me.

Throughout the many experiences I was exposed to during my internship, my favorite remains to be shadowing in the OR. Before surgery, I was given gray surgical scrubs, a face mask, and a hair net that made me feel as if I was actually part of the team even though I was only watching. After watching a ventral hernia repair and a sleeve gastrectomy I soon understood why it is called an ‘operating theater.’ The OR team moves around the patient with the control of well-rehearsed actors and cuts are made with the precision of a sharply delivered line. In laparoscopic surgery, ports are inserted into the body and a camera is moved throughout the ports. Once the ports are inserted, the lights are dimmed and from inside the stomach of the unconscious patient glows a steady red color. If you, like I, were seeing the inside of a stomach glow while a camera showed you the pulsing of organs one reads about in science textbooks, it is safe to say your mouth would have dropped like mine. The would-be fatal damage that the human body can survive thanks to skills honed over many years is truly a wonder to think about!

Besides being an expert surgeon, Dr. Smink’s other professional interest was of surgical safety—specifically in teaching non-technical skills through both simulation and a surgical coaching program. NOTSS (non-technical skills for surgeons) focuses on skills in the intraoperative phase of surgery such as situation awareness, decision making, communication, teamwork, and leadership. Most Fridays, my days would start bright and early at 7 a.m. in the simulation lab (Stratus) for OR team training. The simulation lab uses a dummy that can be controlled to have high blood pressure, bleed out, have heart failure, etc. How surgeons respond in a team to fluctuating changes is recorded and then used to assess and improve behaviors in the operating room that impact future performance and patient safety. I loved being behind the one-way glass where I could watch cardiac surgeons try to save a ‘patient’ in under ten minutes. It was like watching the gears of an elaborate clock move fast and in unison, both inherently mechanic and beautiful. After the simulation was complete, there would be a debrief session. Just sitting in on these conversations on how to effectively communicate in a high-stress environment like an operating room was eye-opening. I learned that especially in the context of an operating room where there are many moving parts, people tend to get hyper-focused into their specific subspecialties and communication lines can breakdown along the pathways connecting the individual roles. The more team training I watched, the more I was able to see these small, but important, breakdowns in communication and how they were improved as the session progressed.

While I got to lend a helping hand at Stratus, one of my main projects focused on surgical coaching for operative performance enhancement (SCOPE). I was brought on board to this project via Dr. Smink who connected me with Dr. Praderelli, a surgical safety fellow completing his research years as part of his residency. Dr. Praderelli has been one of the kindest, well-spoken, and most thoughtful connections that I made during my time here. In summary, prior to being incorporated as a research assistant on the project, I had attended a training session for surgeons that taught them in pairs how to be a “coach” or “coachee.” The coaching program is a research project through Ariadne Labs that entails using a “surgical coach” who uses effective communication skills to guide another surgeon to improve a specific skill. The coaching can be used to improve a surgeons’ technical skills, such as how to stitch together two blood vessels, or non-technical skills, such as leadership techniques or teamwork behaviors in the operating room. Coaching surgeons is a relatively new breakthrough idea that is being pushed forward in order to allow surgeons to continue honing their skills so they are at their peak for every operation throughout their careers (check out Atul Gawande’s TED talk on this!). There are currently only four established surgical coaching programs in existence for practicing fully-trained surgeons. After this initial session, Dr. Praderelli took the time to sit down with me and explain more about the project and things I could help with. As a research assistant, I helped to transcribe audio tapes from post-op debrief sessions and exit interviews. I also was able to learn and utilize qualitative research methods to conduct a thematic analysis of the initial coaching workshop evaluations. The work I did/am still doing for this will qualify me as a co-author on a paper currently being drafted about the coaching workshop design.

Dr. Praderelli also extended the offer of helping to co-write an opinion paper about the power of being a ‘first follower’ of specifically surgical innovations, and how this then translates to a demonstration of a unique, and distinct form of leadership not often emphasized in the medical field. The main argument of the paper follows that first followers may not be the ‘poster-child’ of a cause, but they enact an important public social transaction that can transform ideas into movements. Therefore, though the nature of endowing momentum and credibility onto the initial leader, there is something inherently valuable about being among the first followers to embrace a new vision. The argument of the paper is supported with examples of this phenomenon in surgery including the WHO surgical safety checklist, ERAS, and surgical coaching. We are currently working on this paper together with the goal of submitting it to a peer-reviewed journal!

Lastly, working with Dr. Smink, I also started the process of conducting a scoping review of the current information pertaining to leadership development programs (LDPs) within surgical residency in order to determine the extent to which the topic has been studied as well as to examine the nature of a successful LDP at the residency level. The results of the review will be used to inform the design and development of leadership curricula for surgical residents at Brigham and Women’s Hospital. Due to the short nature of a summer internship, I was not able to see the project through to the end. However, in the time I was on the project I learned a lot about the methodology and software used to organize and conduct a review such as this. I also was able to conduct research meetings on my own with the Harvard medical research librarian assisting us with the project; this took time and preparation but made me feel trusted and capable.

I am excited that I was able to have this experience at the pivotal halfway point in my time at Williams. Through my time at Brigham, I have gained excellent insight into the roles of high level, specialized healthcare providers, and how these providers use their connections made available to them by an urban environment to better their own practice. My time spent at both Stratus and Ariadne exposed me to the value of constantly improving health care services in innovative ways in order to provide the safest and best quality care possible. Additionally, I learned a lot about how to pro-actively advocate for myself in order to make sure I was getting the fullest possible summer experience (which is how I ended up on all the projects detailed here and more!). At the moment, I am decidedly on the pre-medical track, majoring in biology and concentrating in public health. I am not sure what exact career path I want to take in the medical field, but my time at Brigham has opened my eyes to a wide variety of possible options (maybe even surgery which was very much off my radar before!). Furthermore, I know that what I want to do eventually should have a component of consciously and constantly working to be better in order to provide the best possible care. I am genuinely and truly grateful to the ’68 Center for Career Exploration and the Class of 1972 for making this summer internship possible.