Terumo Cardiovascular Group

Mississippi Hospital a Key Training Ground for Future PA-Cs Interested in Learning Vessel Harvesting

Buoyed by a donation from Terumo Cardiovascular Systems, this staff member takes on the challenge of teaching students the elements of CV surgery—with a focus on saphenous vein harvesting.

Not only does Jose Sosa enjoy the challenge of providing top-notch cardiovascular care himself, but he's passing along his knowledge and skill to a new generation of cardiovascular physician assistants (PA-C).

With support from industry pacesetter Terumo Cardiovascular Systems, Jose, the cardiovascular operating room manager for Baptist Medical Center in Jackson, MS, began training University of Alabama PA-C students under a cardiovascular surgery clinical rotation that began in 2009. He and Baptist had enjoyed a longstanding relationship with Terumo, and he wanted to begin training students using the company's increasingly popular VirtuoSaph® Endoscopic Vein Harvesting System. A clinical rotation was quickly established.

Jose told Terumo that he was interested in finding some students to come to Baptist to hone their skills in CV surgery, particularly as they relate to vessel harvesting. A series of conversations between Baptist and Terumo ensued, and eventually Terumo provided a generous educational grant that allowed Jose and Baptist Medical center to begin the rotation.

Jose added, "It's good to teach, it keeps us as clinicians on top of our game—I have to know what I'm talking about if I'm going to teach, and it reinforces everything I've learned and what I do. Also important, we get to see the new crop of students and help them along the way. If some of them had an interest in us and we had an interest in them, we could bring them on board as PA-Cs."

Program growth continues

During the first two years, a total of five students participated. This year, six are expected to complete the program—more than were trained during the entire first two years combined.  Additionally, six more are expected to complete the rotation in 2012. Most students are enrolled in the elite University of Alabama, Birmingham, PA program, and there is one overriding criterion for participation: all must have a desire to perform surgery.

Terumo's restricted educational grant is used to provide teaching supplies and tools including educational materials. It also helps pay for the lodging of students while they are enrolled in the program.  Students are trained using the VirtuoSaph system, which Baptist has used for several years with great success.

According to Jose, the UAB union was ideal, too. The hospital and UAB had enjoyed a relationship going back many years, although the training that Baptist provided did not focus on vessel harvesting. At that time no sponsor was needed, as students from the local area who attended the university could complete a rotation at Baptist and live at home.

The current program goes a step further. "With me here and Terumo involved, we are really concentrating on getting them to learn how to harvest veins in eight weeks," Jose said.

Baptist Medical Center has served Mississippi since 1911. Today, the hospital is part of a growing health network focusing on comprehensive care, education, risk assessment and wellness. Among its centers of excellence is the Baptist Cardiovascular Center, ranked among the top 5% of vascular surgery programs. The CV program completes about 250 heart surgeries each year and an estimated 300 vascular cases.

Teaching excellence a key

Jose, too, is known for excellence. He has a love for teaching, serves as a proctor for working PA-Cs who want to become better vessel harvesters, enjoys imparting to students his experience harvesting vessels and performing other CV responsibilities, and uses the VirtuoSaph system exclusively.

Early in his career at Baptist, Jose was approached about his interest in teaching, and he responded enthusiastically.  He is excited to train his students on this use of the VirtuoSaph system because it helps harvest vessels cleanly and easily.

Developed by Ann Arbor, MI, based Terumo, a leading innovator of medical devices for cardiac and vascular surgery, the VirtuoSaph system features a dissector rod with atraumatic conical tip that has built-in centering rings.1  The open system distal insufflation design and a non-occlusive trocar may help lower the risk of both CO2 embolism and intraluminal clot formation. A harvester rod with V-keeper, V-lock and V-cutter technology featuring a simultaneous cut and seal capability ties the system together.

The Terumo technique includes the cutting triad which facilitates an optimal conduit through the simple combination of branch tautness, grounding the branch at the tunnel wall and maintaining a lower wattage setting on the generator. This ensures reliable and repeatable success with hemostatic division of branches.

Students, hospital benefit

As they learn aspects of their future profession while working and studying at Baptist, students benefit the hospital as well. They assist with many of the tasks normally done by Jose and his team. In addition to seeing patients on the floor, they write preliminary notes and even encourage potential PA-C students who visit the hospital to observe them in action and map a possible career path.

During a typical semester, students are first acquainted with staff and the department. A foundation for surgery is then built, including familiarization with vein anatomy, knot tying on tissue, suturing with proper surgical technique, and putting sterile technique into practice in the operating room. Eventually, they cover all aspects of surgery—from preoperative assessment to postoperative care. Once their confidence and knowledge levels are elevated, students progress to close tissue and eventually harvest veins using the VirtuoSaph system under the strict oversight of Jose.

"How much we allow them to do is based upon their skill level," Jose said. "The hardest things for PAs to learn are surgical technique and vein harvesting. In eight weeks I can usually get everyone to harvest a straightforward vein—with me closely watching."

He added, "Every surgeon wants an experienced vein harvester."

Relationship a natural

Baptist has a long and enjoyable history with Terumo, shares its interest in education, and its VirtuoSaph system is an uncomplicated device that is both effective and easy for students to learn and use.

One such student is Corrie Doyle, who entered the program in April 2011.

"I learned about the rotation from other students who had really enjoyed it," she said. "They told me there would be vein harvesting opportunities that I wouldn't get around Birmingham and that their experience with the program was very positive. It intrigued me."

While in the program, Corrie is immersed in the hospital and the rotation.

"I'm looking forward to learning how to do CV surgery correctly, basically having the right surgical skills," Corrie said. "I'm told there will be a lot of one-on-one experience in the OR, and I'm looking forward to that. This week I learned how to tie knots correctly."

Katherine Long, a senior PA-C student at UAB, completed the rotation in March 2011. She was impressed with the program's hands-on approach to learning.

Student lauds program independence

According to Katherine, there were many opportunities to practice technique outside of the operating room, making her more prepared when she was in the OR. Additionally, students were given a fair amount of independence—to see patients and to participate in consults.

"By the end of eight weeks, I had learned a lot about cardiology, cardiovascular surgery, general OR techniques and interacting with patients independently," she said, adding that she was able to harvest a vein on her own. "I was very proud of that—it boosted my confidence to be able to do all that I was able to do.

"The program was extremely useful."

William Harris, M.D., Chief of Cardiovascular Surgery at Baptist Medical Center, has worked with Corrie, Katherine and other students. So far, Dr. Harris, who trained at UAB and completes about 200 surgical cases per year, has been favorably impressed by the program and with the quality of students, whom he regularly talks with, urges to research topics, and quizzes.

"I view PAs as being another physician," he said. "I want them to learn to look at patients and problems the way that I do. I don't want them to simply learn how to take a vein, but to understand how cardiac bypass procedures work and why we do what we do. If they can learn to think and work like I do, then they can function as another set of hands that can help me."

He added, "I enjoy seeing what kind of people the schools are turning out."

Dr. Harris said the growth he has seen in students over the course of eight weeks has largely depended upon their length of time in the college PA program.

"What we have seen here is really a credit to Jose," he said. "Jose is an incredible teacher. Almost everyone who has come through here has harvested at least one vein, and often multiple saphenous veins endoscopically pretty much alone. He's able to teach them in a pretty short period of time how to do that, and that's pretty impressive."

Indeed, the effectiveness of the program, the quality of students and the ability of Jose to effectively pass on his knowledge all combine to create an impressive educational scenario. Its success has touched Jose.

"Everyone who works in medicine has been taught by someone else," he said. "I'm a big believer in paying it forward, and with Terumo's generosity I'm able to do that in what I believe is a meaningful way. It's a good feeling to teach someone and to watch that person succeed, and that's something I thoroughly enjoy doing. I guess I'm just passionate about teaching."