Officials initiate surgical specialty training in Iraq

  • Published
  • By Sue Campbell
  • 59th Medical Wing Public Affairs
LACKLAND AIR FORCE BASE, Texas (AFNS) --  Optimally managing the unique head and neck injury patterns seen in Iraq and Afghanistan has led to a successful initiative out of Wilford Hall Medical Center here: sending the first surgical fellow to a war zone for a surgical rotation.

In the past, medical and surgical residents and fellows were not deployed to combat zones for hands-on training. Concerns over issues including preparedness for this intense experience, safety, supervision and work-hour restrictions made this type of experience difficult to plan.

"The Accreditation Council for Graduate Medical Education and individual residency review committees have very strict rules regarding a surgical resident and fellow's work-hours, time away from work, supervision, and fatigue management", said Col. (Dr.) David Holck, Ophthalmic Plastic and Reconstructive Surgery Fellowship director and chairman of the Department of Ophthalmology at Wilford Hall. 

"Yet, we realized that some of the best experience a military surgeon can receive is in a combat zone," Doctor Holck said. "They can gain concentrated exposure to head and neck trauma and optimize their skills in the management of unique war-related injury patterns that are not routinely seen in civilian trauma centers. These include blast injuries from improvised explosive devices, burns, multisystem trauma and combinations of these injuries." 

Doctor Holck initiated this project by taking his fellow, Maj. (Dr.) Lisa Mihora, to the Air Force theater hospital at Joint Base Balad, Iraq, for a surgical rotation this summer. 

Doctor Mihora, a board-certified ophthalmologist, is currently in her second year of a two-year fellowship at Wilford Hall as an oculofacial plastics and reconstructive fellow. This specialized division of ophthalmology involves management of deformities and abnormalities of the eye lids, tear system, orbit -- the bony cavity surrounding the eye -- and surrounding face and neck. Facial trauma management is an important component of this fellowship.

"Many Air Force residents and fellows perform rotations at civilian hospitals to obtain the training they need," said Doctor Holck. "We have routinely sent our residents to South America for military-unique training and international ophthalmology. As long as appropriate supervision is available with adherence to work-hour restrictions, there really is no limit to where the training can be conducted." 

Doctor Mihora spent six weeks at Balad, performing more than 130 procedures under the direct supervision of Doctor Holck and another oculofacial plastic surgeon, Col. (Dr.) Randal Beatty.

During this six-week period, Doctor Mihora participated in more head and neck trauma surgeries than in her entire career. This included craniotomies, facial fractures, complex soft tissue facial injuries and enucleations, or eye removals. Additionally, she was a critical member of the head and neck team, operating routinely with neurosurgeons, otolaryngologists, and oral and maxillofacial surgeons. These surgeons treated injured U.S. and allied troops, Iraqi civilians and insurgents, anyone who came through the doors.

"Deploying to Iraq gave me unique exposure to oculoplastics patients," said Doctor Mihora. "The extent of the injuries and surgeries that I cared for were unique to a war zone. Most injuries were from explosive devices, so I am now more comfortable treating these injuries on soldiers when they return stateside."

The ACGME evaluates training programs, residents and staff using core competencies. One of these is systems-based practice, which involves understanding and successfully working in the unique medical system that they will be practicing after graduation.

"If we are going to fully train a military surgeon in systems-based practice, a conflict zone is where they will practice their trade," said Doctor Holck. "Taking Doctor Mihora to Balad not only allowed her to gain first-hand experience, but will help her train other surgeons who may have to deploy in the future."

According to Doctor Mihora, one of the most important parts of the experience was the chance to work with other head and neck surgeons in a team effort to help injured troops. "This was a unique opportunity, only available in a military fellowship program, which has enhanced my comfort and skill level in caring for these trauma patients," she said.

Wilford Hall is the first military facility to initiate this type of program for their surgical trainees.

""With the support of the 59th Medical Wing commander, the graduate medical education department and all our staff, this inaugural rotation was a resounding success," said Doctor Holck. "This is another example of the military, and specifically Wilford Hall Medical Center, leading the way in surgical management of trauma patients." 

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