The victim, a 20-something-year-old woman, is found outside a bar after being attacked. When she arrives by car at the hospital emergency room, she appears woozy, has very low blood pressure, and her heart and respiratory rates are both well above normal. She could die if her injuries aren’t diagnosed quickly and accurately.
The good news — not just for this victim but for all Nevadans — is that this battery case was feigned for the benefit of a class of graduate student-resident physicians attending a UNLV School of Medicine course on trauma assessment.
Their instructor, Dr. Deborah Kuhls, a highly respected trauma surgeon at University Medical Center and a UNLV professor, said she feels privileged to be leading the class.
“I had great teachers, and I want to teach what I’ve learned to others,” she said. “I want to pass it on.”
While the school’s initial freshman class of 60 students has received most of the attention during its brief existence, the nearly 300 graduate medical students attending UNLV are expected to make a more immediate impact on the state’s shortage of trained physicians. State officials are counting on many of them staying in Nevada, which ranks 48th in the nation per capita for physicians across all specialties and 50th for primary-care physicians.
Training with ‘the best’
The doctors who attended the July 30 class at the Clinical Simulation Center of Las Vegas, which sits off Shadow Lane just across from UMC Medical Center and Valley Hospital, are mostly recent medical school graduates from around the country taking graduate courses in emergency medicine and general surgery. They also see patients at UMC during their supervised clinical training.
Dr. Nick Schulack, who attended medical school in Oregon, said he decided to take his three-year graduate emergency medicine training at UNLV because of the clinical training at UMC’s trauma center. The center is renowned nationally, with National Trauma Data Bank statistics showing that while many people arrive with less than a 1 percent chance to live, an amazing 96 percent survive.
“I want to work with, and be trained by, the best,” Schulack said before the class began.
Kuhls began the demonstration by letting the class know that the assault scenario’s fictitious hospital has a surgeon, but it isn’t like UMC, with its huge trauma center and wide assortment of specialists available 24 hours a day. It sounds more like one of the hospitals found in Nevada’s small, rural towns, which have long been difficult to staff.
After she reads off the victim’s vital signs, student-resident physicians Lian Farino and Schulack volunteer to assess the “patient.”
“Where does it hurt?” Farino asks the victim, who appears to be swaying as she stands in front of the room.
There is no answer and soon, Gigi Perez, a young actress wearing makeup to look as if she’s been stabbed, appears to faint. Farino and Schulack place her on a table at the head of the class.
“Can you wiggle your fingers and toes?” Farino asks.
Again, no answer.
A crucial realization
Farino, playing the lead physician, tells Kuhls the patient needs IV fluids and blood and a chest tube insertion to help her breathe. Bleeding must be stopped in the thorax or chest area, where the stab wound was discovered.
After Kuhls reveals that fluid is leaking from the patient’s nose and ears and she has dilated pupils, Farino says it appears the patient has a brain injury.
Farino declares that once the hospital surgeon stops the bleeding and stabilizes the patient, she must be transported to a hospital with a neurosurgeon to handle a possible brain bleed.
Kuhls is visibly pleased. After class she said that a main point of the dramatization was for the student physician to realize that the patient needed a higher level of care than the scenario’s community hospital could provide.
Students were later tested on patient assessment through multiple-choice questions and in simulations similar to what Farino did in front of the class.
That Kuhls became a trauma surgeon, and then a professor at a medical school, wasn’t a sure thing. She started as a banker. It wasn’t until her 30s, she said, that she re-examined her life and realized that she had always had a passion for helping people overcome life-threatening injuries.
After completing her medical training in Maryland in her 40s, she came to UMC 17 years ago. She began teaching soon after — coaching many students from the University of Nevada, Reno, medical school who received their clinical training in Las Vegas.
Since then, she has held patients’ hearts in her hands as she worked to stop the bleeding from gunshot wounds and horrific accidents.
‘We can’t save everyone’
“It is very rewarding to save lives,” she said. “But I also tell students that we have to accept the fact that we’re human and not God. We have to realize that we can do our best — in our hearts we know we’ve done our best — but we can’t save everyone. And sometimes we have to tell someone that their loved one has died. We have to convey that information in a very empathetic way. It is not easy.”
Dr. Dale Carrison, chief of staff at UMC and chairman of emergency medicine at the medical school, calls Kuhls “brilliant in the operating room and in the classroom.”
Her passion for her second profession has impressed the graduate students.
Dr. Krystle Tuano, a resident who plans to be a plastic surgeon, said Kuhls taught her that the best doctors don’t stop helping patients after acute care is finished.
“She’s a great patient advocate, always trying to find resources to help a patient out in the community after leaving the hospital,” she said.
Farino, who has worked with Kuhls at UMC, said Kuhls shows that teaching is an art.
“She can distill the jargon down from the very high level she practices at to something medical students can understand,” he said. “That takes a particular skill that not very many people can do. It’s something I hope I can do.”
Medical school’s graduate programs, fellowships
With the 60 students in the UNLV School of Medicine’s first class of medical students, there are also nearly 300 young physicians pursing their specialties in graduate medical education through residencies and fellowships at the school.
The 11 residency programs are in emergency medicine; family medicine; family medicine-rural; general surgery; internal medicine; obstetrics and gynecology; orthopedic surgery; otolaryngology; pediatrics; plastic surgery; and psychiatry.
Advanced fellowships are available in acute-care surgery; cardiovascular medicine; colon and rectal surgery; gastroenterology and hepatology; hand and microsurgery; minimally invasive gynecological surgery; pulmonary and critical care medicine; sports medicine; and urgent care.