Zhang Kai Department of Orthopedic Trauma
From September to October in 2016, I was assigned by Binzhou Medical University Hospital, with other 3 colleagues to the United States North Carolina Wake Forest Baptist Medical Center for a 2-month further study. My brief experience is concluded as follows:
Wake Forest Medical Centers and its resident training system
Wake Forest Baptist Medical Center has now changed its name to Wake Forest Baptist Health, reflecting the change of health ideas. The Medical center is affiliated to the medical school of Wake Forest University. The center is one of the State’s largest medical centers in North Carolina. As an exemplary role of medical core in the southeast, many guidelines such as trauma care system are drawn by the center. Its hospital bed number is 1004, belonging to the General Hospital and research hospital respectively. There are more than 10,000 faculty and Staff. The predominant departments include trauma center, cancer treatment center, etc. Wake Forest University is North Carolina State’s private school, founded in 1843 whose one-to-one teaching in small classes is famous in the United States.With its increased enrollment, 120 in 2015, its academic ranking is also on the rise. Their medical student training objective is to cultivate clinical doctors, so they put a lot of efforts in clinical education. Clinical medical students in their third and fourth year do their lessons only in their spare time. The also have to get ready for the United States medical practitioners qualifications examination, known as Board Exam. They spend a lot of time on clinical practice. The medical profession is highly respected in the US because only the best students can enter a medical school, which means it is an elite education. Medical students themselves also have a sense of superiority. There is still a large gap between the American and Chinese resident training systems. For example United States resident training system’s teaching and learning coordination and active awareness is very strong. In clinical rounds, case discussions and operations, teachers often ask the residenst various questions and give residents a lot of practice opportunities as well, so when the training is over, their clinical thinking and operation skills will be greatly improved.
The procedure in the hospital is very strict, so we must first understand its rules and regulations, especially those concerned with the patient privacy protection system. My job is to observe the surgery, especially treatment of trauma patients and participate in clinic, case discussions and rounds. Each outpatient time is relatively fixed. Doctors ask the disease history and check patients very carefully, which probably needs 20 minutes, the relationship between the doctors and the patients is harmonious. They talk and shook hands like friends. Doctors answer the patients in simple language. They often repeatedly ask the patient if he understand the key issues. Most of the patients can understand and are able to actively cooperate with the doctor’s treatments, such as nonunion, the steel plate rupture and so on.
Wake Forest Medical Center has a total of 40 ORs, with Monday-Friday routine surgeries, and about 150 daily operations. Orthopedic outpatient surgery includes removal of plants, simple limb fractures and carpal tunnel syndrome, and cubital tunnel syndrome surgery. The Medical Center has 47 orthopedic surgeons; orthopedics’ subsubjects include orthopedic trauma, spine surgery, joint surgery, sports medicine, and foot and ankle surgery, hand surgery and so on.
The operation verification regime and the system of consultation
My main focus was to observe the orthopedic surgery and other related specialized surgeries in the operating room. The verification process does not only hangon walls in each room, but also deep root in the heart of each faculty and staff. According to the process from start to finish, I found that regardless of the length and complication of operation, each operation is strictly performed, and the process is very smooth. Verification of nurses and anesthesiologists are also very rigorous. Other important rules and procedures in the operating room are also reflected on the walls. What is worthy of being praised is its consultation system, which is complete and smooth.
The air rescue services and MIT
Wake Forest Medical Center is the region’s only level AI trauma center which provides 24/7 air rescue services. Helicopter after receiving the emergency call is ready in 10 minutes to arrive at the scene, while the Center preparing the rescue facilities. Aircraft is equipped with sophisticated life support and patient testing equipment.
For example, if a traffic accident occurs, ground transport, the helicopter will arrive at the scene to transport patients to hospital trauma centers, professional doctors and surgeons in the hospital emergency are ready in the emergency room. Each doctor is equipped with pagers ready for call for participation in the rescue.
The development of orthopedic instruments and equipment makes minimally invasive treatment (MIT) possible for patients with traumatic fracture. Wake Forest Medical Center's orthopedic trauma doctors take it to new extremes with technology to achieve superb level of closed reduction and internal fixation. The pelvic and acetabular fractures are more complex diseases. The tibial plateau fracture and intra-articular fracture of ankle fracture can achieve anatomical reduction, which creates conditions for the subsequent rehabilitation to achieve anatomical reduction measures including retractor applications, application of reduction and forceps, lag screws and Kirschner, and repeated examination under C-arms.
While two months of study is short, I tried to make full use of this opportunity to learn as much as possible. I will share the latest technologies and ideas I learned with my collegues as early as possible and improve the expertise of trauma treatment at BMUH.