2018 graduates grateful for the experience they gained, look forward to their next chapter

Clark Chen, MD, PhD; Gupte, Goyal, and Professor Stephen Haines, MDAs they prepared for graduation on June 22, 2018, Chief Residents Amit Goyal, MD, and Akshay Gupte, MD, MPH, reflected on the seven years they spent as U of M neurosurgical residents. They gained experience at four sites: University of Minnesota Medical Center, Hennepin Healthcare, U of M Masonic Children’s Hospital, and the Minneapolis VA Healthcare System. They also provided patient care at the Clinics and Surgery Center on the U of M campus. They are pictured to the right with (from left to right): Neurosurgery Department Head Clark Chen, MD, PhD; Gupte, Goyal, and Professor Stephen Haines, MD.

What aspects of your residency helped prepare you best for what’s next?
Goyal: Pretty much from day one, we were expected to manage patients and their problems, coming up with diagnoses and treatment plans. It prepared us well. I also spent lots of time in the operating room and attended quite a few courses. Much of my independent study time was spent in the U’s Neuroanatomy Lab doing dissections.

Gupte: Our program at the U is extremely strong. The combination of clinical and surgical training we received built lots of skills. We had the appropriate amount of supervision to build our confidence enough that we can go out and practice on our own. The faculty in the different hospitals in which we were taught really paid attention to that, especially in the later years.

What will you never forget, based on your experience at the U?
Gupte: No matter what time of day or night, always do the right thing. Treat your patients like you would want to be treated ... or you would want your family to be treated.

Goyal: I’ve forged lifelong friendships here … people I will never forget. I also learned general principles about how to do and not do things.

Akshay Gupte, MD, MPHAkshay Gupte, MD, MPH

What were some of your challenges?
Gupte: Coming from India, it was a challenge to learn how to practice in an electronic-based system and to learn the way surgery is done in the United States. In addition, our faculty often differed in how they approached some of the disorders we treat because they can be treated in different ways. We eventually learned how each of them approached things. That’s the beauty of learning from so many different people – you get to choose the best of what you think works from your training and blend it into the way you treat your own patients.

Goyal: Time management was a challenge, that’s for sure. In neurosurgery, you also have a lot of strong personalities and a lot of strong opinions. You learn how to navigate that, whether it’s with your peers, superiors or even your juniors.

Where do you see the program going in the next five to ten years?
Goyal: As the new department head, Dr. Clark Chen has big plans. The faculty size is increasing and that should translate into additional patient volume. Who knows? In ten years, the program might be able to add another resident or two.

Gupte: Thanks to Dr. Chen’s influence … and that of the new faculty … residents are being encouraged to do more research. It will help the program build not only its national reputation, but its international reputation as well.

Can you recall a few patient experiences? What made them memorable? What did you learn?
Gupte: Getting to work with the veterans at the VA hospital … they are such a special population. Learning from them, about their love for their country and for their doctors, was a wonderful experience. At Hennepin Healthcare, we worked with trauma patients. We spent weeks taking care of those patients and built relationships with their families. I cherish that. To see those patients do well, after arriving at the hospital in extremely bad condition, was just amazing. At Masonic Children’s Hospital and the University of Minnesota Medical Center, patients tended to have very complex conditions and you’re their ultimate hope. Getting that sense from the patients and their families makes you feel wonderful and inspires you to work hard to prove them right.

Goyal: When I was in Pediatrics, we had to have a lot of tough conversations. I remember a 16-year-old patient with a high-grade tumor who calmly asked me if he was going to die. Many of my patients are memorable because of the emotional impact they have. It teaches you to keep the human aspect of all this in mind.

Amit Goyal, MDAmit Goyal, MD

What difficult learning experiences were you glad you had?
Gupte: Every 30 minutes or so when you’re on call, you’d have a couple of new consults, some of which are critical. You learn to prioritize things every few minutes, depending on how your patients are doing. It’s challenging, but you come out stronger.

Goyal: For me, it was learning how to deal with technical issues in the OR. If you have bleeding from a major vessel, how do you deal with it? We read about it in books, but it’s different when you’re there. You get a rush of adrenaline that stops you from thinking for a second. It’s difficult to deal with. The first time I ruptured an aneurysm in the OR, I got that rush. And then I remembered having observed an attending who had the same thing happen. I knew what to do and handled it just fine.

What advice would you give new residents?
Goyal: You will grind through a lot of stuff, but it won’t be forever. Part of that will never end – that’s just life for us – but things will get better as you progress through the residency. Try to set some goals and achieve them early on, whether it’s in research, patient care, the OR, or education. And at the end of the day, no matter who you’re interacting with at the hospital, you should try to maintain your humility, try to be kind to people. That’s what people will remember about you. No one will really know how smart you are or how much you know, but they will know how you talk to patients and how you return a page. You’re never too important to be kind.

Gupte: Soak in as much as you can. Every time you feel comfortable in a certain role, you’ll be advanced to the next level and must handle five more things that you have no clue about. But the more you advance, the more fun it gets. Never forget there are no routine cases; each one will give you something new. Get in the OR, operate, and learn from every single case, even though it seems mundane. Neurosurgery is one of the toughest residency programs. It’s demanding physically and mentally, but at the end, you come out stronger than you thought you ever could be.

Do you know where you’re going after graduation?
Gupte: I will start a fulltime practice in general neurosurgery at University Medical Center in El Paso, TX.

Goyal: The first week of July, I move to Sydney, Australia, to begin a six-month fellowship at the Centre for Minimally Invasive Surgery, which is affiliated with Prince of Wales Hospital. After that, I start full-time at a practice in Dover, DE.

We wish all the best for these new neurosurgeons as they start the next chapter in their stories.

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