Illinois Medicine

PHOTO: LLOYD DEGRANE Pier Christoforo Giulianotti, MD, shows fifth-year surgery resident Kendra Grubb, MD, some of the fine points of using the robot for surgery. B most important factor is experience," Giulianotti says. "When you're an experienced surgeon, the difficulty of using robotics is less and less." Y THE TIME KENDRA GRUBB BEGAN HER THIRD YEAR of residency in the fall of 2007, robotic surgery was part of the Illinois Medicine surgical residency program, which aims to provide sufficient training in surgery fun- damentals that physicians can begin practice immediately after residency while also having sufficient experience to go on to train in advanced sub-specialties. The program annually admits seven residents, and on average about a quarter of them go straight into practice when they're done, with more than half of the program's gradu- ates remaining at academic medical centers, assuming responsibility for advancing surgical practice themselves. "We do a good job of educating residents about both the cutting- edge stuff and the principles of surgery that have been there for 150 years," says Gary Merlotti, MD, director of the surgical residency pro- gram. For example, half of the Wednesday morning resident conferences are simple case presentations, while the other half are given over to what Merlotti describes as "very high-level didactics." Robotics training falls into the latter category. In the Illinois Medicine lab, residents become familiar with the imaging and they prac- tice hand control of the robotic tools on plastic models. Once they've learned how to work with the technology, they can begin to apply it to surgical procedures in which they've already proved competent. "You cannot forget the principles of traditional surgery. If you have a com- prehensive and well-developed grounding in them, the development of robotics skills is faster and more effective," Giulianotti says. By the end of the program, most Illinois Medicine residents will have been involved in about 100 robotic procedures, out of the 1,000 to 1,500 surgical cases in which they'll have participated overall (well more than the 750 cases required for board eligibility). "We definitely have the most well-organized robotic training program in the country, and people are looking to us to be a leader in how surgeons are trained in robotics elsewhere," Merlotti says. For Grubb, her training in robotic surgery is the latest step in her rigorous journey to a medical career. Growing up in Olympia, Wash., she was inspired to become a surgeon by watching her veterinarian father operate on animals. She still remembers him healing a Jack Russell Ter- rier with a broken leg when she was 5 years old. "You see an animal who couldn't walk and the next day he's walking," Grubb says. "I thought it was magic." Grubb spent 10 years at the University of Southern California, where she earned undergraduate degrees in biology and East Asian language and culture, a master's degree in health administration and her medical degree. She then came to the medical center for her surgery resi- dency, drawn to the program by its clinical emphasis and opportunities. "The residents operate a lot, and they train in places like the VA [Jesse Brown VA Medical Center] and county [John H. Stroger Jr. Hos- pital], where residents are allowed to run a team and make decisions," Grubb explains. "And at U of I, you see all the unique presentations, the advanced disease that your typical community surgeon can't deal with and sends here." She'll have been involved in more than 1,500 surger- ies and procedures by the end of her residency, including nearly 900 in which she was primary surgeon. "She's what you want a surgeon to be. She learned very well how to assess medical problems and move forward, she's very decisive, and her technical skills are superb. She's an outstanding resident," Merlotti says. Grubb's training isn't done, though. When she's finished at the medical center, Grubb will begin a fellowship in cardiothoracic surgery at University of Virginia Health System in Charlottesville, and she expects to remain in academic medicine for the duration of her career. "I love teach- ing and mentoring," she says. "I can't think of anything more gratifying than continuing to master a skill while teaching other people to do it." That desire to be a clinical leader fueled her interest in robotics, which already is used in surgery on the heart's mitral valve. Grubb is in- terested in finding other applications for cardiac surgery. "Think of doing open heart surgery through an incision this big," she says, holding her thumb and forefinger an inch apart. "That's amazing." Even if she's part of a generation of physicians who use robotics to usher in a new era of surgery, Grubb knows her medical education won't end there. "Robotic surgery will not be the last advance in surgery," she observes. "There always will be a next step. I want to be part of that." I L L INOI S MEDICINE | 35

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