Cardiac surgeon and Harvard Medical School (HMS) professor John E. Mayer Jr., YC ’68, MD ’72, was troubled by a trend among the medical students he taught in recent years. Increasingly, students who Mayer was sure would make excellent surgeons were opting for other careers, attracted to the lifestyle and other factors offered by nonsurgical fields. Mayer’s expectation was that if they were exposed to surgery early in their education, more would be drawn to consider surgical careers.
It's a problem in American health care. According to the Association of American Medical Colleges, the United States will see a shortage of between 10,000 and 20,000 specialty surgeons by the year 2036, as more surgeons retire and demand for surgery rises due to an aging population. The shortage in cardiothoracic surgery alone will be 1,540 by 2030, according to a 2022 analysis published in the American Journal of Surgery.
“It’s been more and more difficult to fill the available residency and fellowship slots in our field,” says Mayer. Given this trend and the projected needs for surgery talent, Mayer believes that ensuring a high-quality pool of new medical students going into the surgical and procedural specialties should be a priority for medical schools.
His experience at HMS, and more recently at Yale School of Medicine (YSM), suggests that the anatomy lab is an ideal place to stimulate interest in surgical fields by teaching anatomy from a surgeon’s point of view.
The new Advanced Surgical Anatomy elective at YSM goes beyond the basics. As the course directors Mehra Golshan, MD, MBA, professor of surgery (oncology, breast), and Adnan Prsic, MD, assistant professor of surgery (plastic) note, this elective complements introductory anatomy, which typically focuses on the organs and other structures of the body and their physiological functions. Surgical anatomy looks at the body in the context of a surgical procedure.
“It’s less about cutting the skin to see what’s underneath and more about cutting the skin to get to a place,” Prsic says. As he tells students: “If you really want to see this, you have to be gentle. … And I think a lot of them have a deeper and greater appreciation for the surgical field when they’re told, ‘You can’t just cut to the bone, because there are 40 other structures in between that you have to work around.’”
Golshan says, “The course is about taking the leading proceduralists at Yale School of Medicine—for the first time combining six surgical/procedural department faculty—to allow for graduating seniors to hone their skills and be taught by the leaders in their fields before going into surgical training programs around the country and here at Yale.” He adds, “This was hands on, one faculty member with one, two, three, or four students going through complex and common surgical procedures, as well as pearls and pitfalls to look for along the way.”
The new elective made its debut last spring. “The Phase I pilot was wildly successful. All the students raved about it,” says Jessica Illuzzi, MD, MS ’06, deputy dean for education at YSM. Equally important, she adds, it has generated excitement among a growing group of surgical faculty who are energized about teaching anatomy and creating innovation in the curriculum.
Conception and Launch
Mayer, who stepped out of the operating room several years ago but continues with laboratory research and teaching at HMS and Boston Children’s Hospital, and is loving teaching anatomy at HMS, has been a longtime supporter of medical education at YSM. In 2021, he met with Illuzzi and Michael Schwartz, PhD, associate dean for curriculum, to learn more about philanthropic priorities within medical education. He mentioned that he had been involved in teaching a surgical anatomy course at HMS and would be interested in supporting a similar one at YSM, in part to excite student interest in surgery and other procedural fields.
The conversation came at a time when Illuzzi and Schwartz, prompted by student feedback, were considering ways to supplement anatomy training to better prepare students for their residencies.
“We learned that it’s really important to review and revisit anatomy during the advanced training period … especially for those students entering surgical specialties,” Illuzzi notes. Mayer’s interest and support could not have come at a better time. He agreed to provide seed funding to develop this surgical anatomy elective at YSM, and Illuzzi engaged surgery faculty members Golshan and Prsic to lead development of the course. They recruited others from six surgical/procedural departments to help shape, and ultimately teach, segments of the course.
In April 2023, YSM launched the surgical anatomy elective with support from the John and Christine Mayer Fund for Medical Education. Open to fourth-year medical students, the pilot enrolled seven students, all going into surgical fields. Over four weeks, the students revisited the anatomy of most organ systems, engaged with various surgeons, learned about surgical approaches and how to attempt to surgically address various problems, and practiced procedures and surgical techniques, learning about their linkages to anatomical structures. They reviewed procedures ranging from common to the most complex, such as a heart transplant (the last session of the course).
Because the pilot was a big success, the elective was repeated this spring. Enthusiasm for the course led to more than 40 applications for eight slots.
“Our course is really popular. Word has spread, and even first-year students know about it,” says Prsic
The Desire to Make a Difference
A driving force for Mayer has always been his desire to make a difference—to serve patients, to give back, and help prepare the next generation of doctors.
He chose a career in pediatric cardiac surgery because, “You knew that if you got the anatomy repaired correctly, you could really have a positive impact on that child, not just for the next few years but for their entire life. With a single operation, you could markedly improve the prognosis of a disease process. I have patients I operated on 30 years ago who are now grown up, have careers and families, and are doing well ... so you know that you made a difference.”
Moreover, at every opportunity, he strives to pass on his enthusiasm and knowledge to others.
Mayer hopes that the new surgical anatomy elective at YSM is “helping give students just a flavor and a hint of what a career as a surgeon might be like going forward.” He hopes it is “helping students experience the reward of seeing a problem, trying to conceive a solution, actually creating a solution by cutting and sewing, and then seeing a good anatomic result.”
That was the case for Natty Doilicho, MD ’23, who took the elective last year and is now a general surgery intern at Washington University. He wrote to the faculty, saying what he learned during the elective “is the experience I’ve drawn on most frequently, and the one that has allowed me to instruct myself more and more with each patient’s case.”
It has been such a success, Illuzzi says, that a similar elective will be offered in the first year, and surgical anatomy will likely be integrated into the introductory anatomy course. This will give students exposure to surgery before they have chosen a field and may boost the number of applicants for surgical residencies.
Doilicho was so inspired by the course that he made his own gift to the Mayer Fund and plans to do so yearly. “It wasn’t a hard decision,” he says. “It’s the best course I had.”