UCSF Fresno Surgery Residents Win National Competition with Precision Skills

Creating recognizable images with pen and pencil in a timed game of Pictionary can challenge the artistic abilities of even aspiring Picassos, but imagine trying to draw legible figures on a camera screen using laparoscopic tools.

UCSF Fresno surgery residents Sean Meshkin, DO, and Angela Nieh, MD, did just that – and deftly maneuvered pen-shaped instruments on a laparoscopic simulator to take first place at the 2019 “So You Think You Can Operate?” Surgical Skills Competition at the American College of Surgeons (ACS) Clinical Congress held in San Francisco.

The national surgical skills competition pitted eight teams of surgery residents selected from programs across the country. The teams competed in a series of skill-based challenges culminating in UCSF Fresno facing off in the laparoscopic Pictionary finals to best the second-highest scoring team, Beaumont Health, from Michigan.

This is the third year for UCSF Fresno to compete in the competition, and its first win. Last year, UCSF Fresno made it to a final laparoscopic Pictionary game, but lost.

Each surgical skills team has two members – a senior resident and a junior resident. UCSF Fresno surgeon Amy M. Kwok, MD, the surgical skills lab director at UCSF Fresno, chose the members for the UCSF Fresno team, the “X Blades.” Dr. Kwok had confidence in the surgical skills of Dr. Meshkin, a fifth-year and chief resident, and Dr. Nieh, a third-year resident.

“What I do every year is I hold a Surgical X Games competition at the simulation lab at UCSF Fresno for all of the residents here, and the top scorers in that competition are the people who qualify for the national team competitions. Drs. Meshkin and Nieh did very well in the Surgical X Games so they were submitted for our national ACS team this year,” she said.

While the ACS competition is a good-natured event, it also tests residents on surgical skills they are learning in residency, Dr. Kwok said. “It’s a nice format for them to come and compete against one another, but everything is actually very functional. These are skills we teach the residents pretty much year round. They ask the residents about indications for a procedure, risks and common problems to assess surgical judgment, as well as testing their skills knowledge.”

UCSF Fresno offers a well-rounded surgical training program that provides residents with a broad exposure to subspecialties of general surgery, including trauma, acute care surgery, burns, vascular, plastic, endocrine and colorectal surgery. Residents primarily train at Community Regional Medical Center, the only ACS verified Level 1 trauma and burn unit serving the San Joaquin Valley with a population of four million people. Residents have exposure to a wide ranging patient population of all ages, from pediatric to geriatric and, most importantly, to rare surgical pathologies and advanced disease processes.

This year’s competition involved a number of laparoscopic contests, including a simulated laparoscopic gallbladder removal and dexterity contests (in addition to the laparoscopic Pictionary finals round). Other techniques judged in the competition: a colonoscopy performed using an endoscopy simulator; vascular suturing; simulated placement of a resuscitative endovascular balloon occlusion catheter (floating a balloon catheter through an artery to stop the flow of blood in the abdomen or chest); and a vacuum-assisted closure of an abdominal wound using a patient care manikin.

The residents also had to identify surgical instruments by feel that were hidden inside boxes, spelled the name of each instrument correctly and wrote a sentence to explain the use of each instrument. They also assembled a Thompson retractor, a surgical instrument used to separate the abdomen, and then did a simulated retraction.

There’s also a component of teaching and communication in the competition. The senior resident (Meshkin for UCSF Fresno) talked the junior resident (Nieh) through performing several of the techniques, Dr. Kwok said.

Drs. Meshkin and Nieh were determined to win the national competition.

“Knowing this is my final year, I knew I had one shot, one opportunity to seize this chance to win the competition, Dr. Meshkin said. “The stakes were high, but we had a great team, great support and years of incredible training that had prepped us. Angela and I were certainly nervous but on the surface we were calm and ready. We trusted our training and thanks to some great vascular anastomosis and creative laparoscopic Pictionary, we came out victorious.”

Dr. Dieh said she too was nervous, but “with the support of our attendings and fellow residents who showed up to cheer us on, we pulled through.” The contests were fierce, though, she said. “We met with diverse challenges that tested our clinical judgment, teamwork, fine suturing, laparoscopic and endoscopic skills.”

UCSF Fresno hopes residents will get another chance to show their surgical skills at the northern California ACS meeting this coming spring. Teams from UCSF Fresno, UC Davis, UC East Bay, UCSF, Stanford, Kaweah Delta Health Care District and San Joaquin General Hospital compete in the event. At that competition, the UCSF Fresno X Blades will have to sharpen their game show skills. “The competition is going to include surgical Jeopardy,” Dr. Kwok said.