While we were in California doing some work with Stanford University recently, we had the chance to chat with Dr. John Paro, MD. Dr. Paro is a 5th Year Resident Plastic and Reconstructive Surgeon at Stanford University Medical Center in Palo Alto, CA. Additionally, Dr. Paro has co-authored two virtual surgical simulations on the Touch Surgery surgical simulation app, a Carpal Tunnel Release (which was featured as our 3D simulation) and a Breast Tissue Expander procedure.
Touch Surgery: Can you tell us a bit about what sparked your initial interest in medicine?
Dr. John Paro, MD: I always thought medicine. I wasn’t sure why, no one in my family does or is in medicine and I never had that much interaction with people in medicine growing up. When I got to college, I did some shadowing just to make sure I would actually like it – I spent some time with surgeons in the OR and took pre-med classes, although a lot of other various classes as well.
TS: And how about your interest in surgery?
JP: So when I got to med school, in a similar way to how I had no idea why medicine would be fun, I had a sense surgery would be really interesting. I think a large part of it was because the immediate change you can make as opposed to giving medicine and waiting, as well as the ability to work with your hands. During medical school, the first two years you don’t get that much experience with patients. Then the third year, you start getting to see patients and doing rotations in various specialties. When I did my surgery block, I really liked it, and so then I started thinking about which type of surgery I wanted to get into, and was very interested in plastics.
Plastics is very different from how it’s portrayed in the media – the layman’s understanding is facelifts and nose jobs and other aesthetic procedures. We learn how to do all that and it can be fun, but the real challenging procedures in plastics are reconstructive – it’s basically surgical problem solving. You learn a set of skills and underlying anatomy. Then you’re given a riddle of: how you fix this – and there’s not always one right answer. With cancer, you really only have one path: take the cancer out. But when you’re looking at a reconstructive challenge, there’s a significant element of creativity that goes into the solution. I really like that. I’ve never have been an artist apart from some stuff with music and songwriting and video, so I enjoy having the opportunity to be creative. I’ve found that for me, plastics is the most creative surgical specialty.
TS: What advice would you give to someone in medical school or surgical training in regards to picking a specialty?
JP: It’s really quite difficult. I would say that at the stage when you’re considering going to medical school, the most important thing someone can do is spend some time in a hospital taking care of patients to make sure that they actually like it. It really sucks to go through your entire undergraduate pre-med curriculum and then enter medical school and get halfway through and realise that you don’t really like medicine. You really have to do as much as possible to make sure you’ll enjoy it. People don’t really go into this anymore to make a boatload of money, because frankly if you don’t really love it, you probably won’t make it to the point where you’re actually working in surgery.
In terms of picking a specialty, that might be even more difficult. You really have to go out of your way to learn about the areas you’re interested in to make sure you’ll enjoy it. In medical school, you only have a few weeks on each rotation to decide what you want to do for the rest of your life. Maybe you did two weeks on Orthopaedics and you had a great Chief Resident and the team was great and the attending let you put a screw in a femur, and you think, “this is amazing, I should do this for 30 years!” All to say you have to spend a little more time than that researching and coming to your decision about what will make you happy.
You also have to base it on the bread and butter of each specialty, too. For instance, we’ll get crazy cases like kids who are born without the ability to smile on one side, so we go and transplant a muscle from their leg into their face and they learn how to reanimate their faces and are able to smile for the first time. Those are incredibly inspiring cases, but we do those cases maybe twice a year, so you can’t just want to do those cases – you need to enjoy doing the everyday cases. You need to make sure you’re going into what you pick for the right reasons.
TS: What’s the most frustrating aspect of your surgical training and how might that be different from someone training 25 years ago?
JP: I think expectations are very high in many training programs, which is a good thing – they should be. Unfortunately, every surgeon has that experience where they go into an operation that they’ve never done before. In our field in particular, we do an extremely wide variety of cases, literally from head to toe, which not many other fields do. So by definition, for us, you get that experience of not having ever performed a particular procedure before a lot because there are so many different cases.
The frustrating part to me about that is it’s very difficult to prepare for a case you’ve never done before. You might have relevant technical skills and similar knowledge from performing other similar procedures, but if you haven’t done one in particular, how can you prepare adequately ahead of time? You need to be prepared but not over-confident, and be able to prove that to your attending that you’re competent so that they trust you. Another frustration that ties into that is that there are so many resources available at your fingertips – articles, PDFs, YouTube videos. This is great, but the trouble with having that much access to information is figuring out how to whittle it down to what’s really valuable.
I think that’s potentially one of the real benefits of Touch Surgery, to be able to see what steps are involved and how to perform the exposure of a procedure that you maybe haven’t done before, especially with the addition of an interactive element.
TS: How do you see technology being incorporated into residency programs or surgery in the near future?
JP: It’s tough because the only way to get truly good at surgery is to do a lot of surgery. Even if you’ve done 100 carpal tunnel releases, you’ll still find one where the nerve isn’t where it usually is located anatomically. Hopefully after performing a procedure 100 times, you’ve developed the confidence to know what to do in those uncertain scenarios. That’s how you get really good. However, unless your first few procedures go well, you aren’t going to have the opportunity to do 100 carpal tunnel releases.
The way I see educational technology being really useful is to give people that confidence earlier than they might develop it otherwise. That’s the biggest benefit of an app like Touch Surgery – giving people that haven’t done a particular procedure the confidence to go into the OR with a basic understanding of the steps involved. Touch Surgery is good for a couple of situations – it’s great for medical students that never seen surgery before so they can be ready for the questions they might be asked and even for early stage trainees. It’s also good for higher level trainees to try new cases they haven’t done before – maybe they haven’t tried a particular flap or are curious about a procedure they rarely perform.
I see educational technology being truly valuable to providing experience prior to ever entering the operating – giving people confidence and a knowledge base they might not have otherwise. That could also be really useful to people that don’t have access to the resources like us, and also to people in developing countries who do have access to smartphones but might not have the other resources we have available for training purposes. That could actually be how it’s most useful.
John Paro was recently interviewed by the BBC on Touch Surgery’s value as a training tool. You can watch the video by clicking here.