Surgery Fellow: Melissa Coleman, M.D.

I did. Because my parents worked at the NIH I had done research projects at the NIH since I was old enough, even before I was old enough to officially work. My [senior] research project was in the NINDS, looking at the migration of neurons that work for your sense of smell. They had a summer science program so it overlapped with the senior research project summer between junior/senior year, and I did it all through senior year and stayed in that lab.

When did you decide you wanted to be a doctor?

If you ask my parents, one of the first toys they gave me was a Mickey Mouse doctor set, so I think they were planting the seeds pretty early. I think I'd always had the feeling that I wanted to be a doctor, and I went to college pre-med and it didn't really change over the course of the time I was in college. Both my parents were scientists, so science was always interesting, and being a doctor was always a thing that I thought I would be interested in.

Could you talk about the stages of medical training?

In order to apply to medical school you have to complete a series of pre-med requirements. That can be done either while you're in college through your major which is what I did, or there are people that might decide later on they might go into medicine, so there are post-bac programs that you can to complete the necessary coursework to apply. Then you have to take the MCAT, and apply into a medical school. For most people the traditional track would be four years in medical school.

Once you graduate you're technically a doctor, but don't have the ability to actually practice on your own. So everyone who wants to continue and practice has to do a residency. Residency is, if you think about the broad categories, pediatrics (if you want to do just children), internal medicine, OB/GYN (if you want to do labor and delivery), and surgery. Each of those has finer breakdowns, but that's broadly some of them. So you do this residency which is a period of additional training where you're practicing under the supervision of more experienced doctors. There are different lengths of times: the shortest is probably 3 years, most surgical specialties are probably 5 years, on average you're talking about 6-7. After residency that would allow you in most cases to practice in your field. There's a trend now where people are specializing more and more, so they'll do more training, which is called your fellowship.

Could you talk about what your work is like right now?

I'm in the last part of my training. I'm a little unusual in that this technically this is my third fellowship -- most people have just done one -- but ultimately my interest is in cardiothoracic surgery, heart and lung. Primarily for me I do lung. So I finished general surgery and I have to do an additional three years in just heart and lung surgery. I'm currently in the 2nd year of the three-year program at UCSF. As a trainee we have rotations either on the cardiac surgery side or the thoracic surgery side, and for the most part we have scheduled operations where we're with a senior surgeon and you sort of have this gradual training of learning to perform each of the type of procedures. We're also in charge of taking care of these patients after the surgery and helping them recover and ultimately leave the hospital. We also see patients in clinic. On an average day we get to the hospital around 6 in the morning, review everything that happened with patients that go to hospital overnight, see all the patients, come up with the plan for the day, talk to the senior surgeons about the plan for the patients, and spend the rest of the day in the operating room. Your day basically ends when the work is done.

How did you decide to focus on surgery?

So in medical school for the most part the first two years and in some schools just the first year is the academic part or the class-based part of medical school. You're in lectures and learning all the basics for medicine. Then your last 2 years, your 3rd and 4th, are your rotations. So you're in the hospital or in the clinic and you go through all of the major fields: internal medicine, surgery, pediatrics, all of them. You're not a doctor yet so you can't necessarily do things on your own, but you can be taken through around the hospital with other residents or with more senior doctors so you get a sense of what each of the fields is like. That gives you a chance to decide which field you want to go into.

A lot of people might come to medical school with an idea, some stick with it, some realize in the rotation that it wasn't what they thought it was or want something else. I went into medical school thinning I wanted to do pediatric cardiology, wanted to take care of children with different heart conditions, but my first rotation of my third year I was assigned to surgery and I loved the rotation. I loved being in the operation room and I loved all the time I spent with the surgical residents who were in their residency training. Even though it was tough and there were long hours, I found that I really got along with the residents and being able to do something hands-on during the day for the patients was really rewarding for me. But that was my first rotation of medical school so I thought maybe it's because I'm excited to be out of the classroom. As I started to do the other rotations, I realized I didn't like any of them as much as I liked my time on surgery. When I did my rotation in medicine, we spent a portion of that time in the intensive care unit for patients who have heart conditions and I had a patient who needed a surgery and because I was a med student that was on the rotation, I could go see the operation. On the scale of heart surgeries it was fairly straightforward, so it was actually just the main surgeon; it wasn't a larger group as a lot of operations will have. Because it was just me and the surgeon, he asked if I'd like to scrub in and assist, which I thought was great. Everything fortunately for that patient went really well and I think without a doubt that was my best day on internal medicine. I figured if my favorite day on my medicine rotation was when I went to surgery, at that point I decided I just wanted to pursue surgery.

How has the practice of medicine changed since you started your training and where do you see it going?

I graduated from medical school in 2007. I was just talking to my sister [Natasha Coleman '06] -- my sister is actually also a general surgery resident and graduate from Blair. We were talking about how our older attendings are like, it's so easy for us now, we have the electronic medical records, everything's on the computer. I have to remind them, actually when I started in 2007, we had paper charts, not everything was on an electronic record. I remember having to go to every patients’ room and having to get their records. There was a chart outside their door, you had to decipher peoples' handwriting, and write your notes by hand every night.

I did research for two years, and when I had come back everything was electronic. Obviously as a resident you have a lot of patients, a lot of things you need to do, so it's much more convenient to be able to log on and see all the information for a patient. But it means you don't have to go to the room so in that way it kind of distances you. Before I had to physically walk to the patients’ room, it made sure you were seeing the patient.

In surgery itself there have been so many advances in terms of what we do in the operating room, so much so that some of the [older] procedures are ones that the newer residents and trainees haven't seen before. There's much more minimally invasive surgery. Even over the course of my time when I started, you didn’t hear very much about robotic surgery and now most major hospitals are doing it. There are certain specialties like urology and gynecology that have been using the robots for a while, but it's still in the early period in thoracic surgery. At UCSF they just got the robot last September. It's really interesting to see one of our attendings who before did very open surgery, now using the robot to do all these procedures. Surgery is very stressful on the body so hopefully if you can make it less invasive, you can improve outcomes for the patient, or make surgery available to more patients. Because if you think a surgery is too stressful for a patient, if you can make it less invasive you can make it available for more patients.

There is a focus on more personalized medicine. Especially in cancer, that's where a lot of the research is starting to really have an impact -- looking at the tumor, looking at tumor biology, being able to say that based on the presence of certain mutations that you would do better with a certain set of treatments or another. Even if you have a lung cancer, there are very many types, they're not all the same thing, and [the research allows] tailoring your treatments for that.

It's really cool to hear that research really does go out there and make a difference.

We see patients in the clinic and they've had their lung tumors biopsied and there's a series of known mutations -- for instance if you have an EGFR mutation -- then we know we have a specific medication we use for that. It's really nice to see that translation of that research, to say we can take this, we can take a molecular test, and then impact this patient, hopefully for the better. But I definitely know how it is when you're in the lab and you almost feel like what you're doing is in isolation. And that's the goal, to translate it, to helping a population as opposed to just your experiment in your lab.

How does someone decide if becoming a doctor is right for them?

It's tough. I spent six years as a pre-med advisor at Harvard while I was in my residency in Boston. I think that sometimes people feel like this is something that my parents want me to do, so I'm going to try. It's definitely it's a lot of work once you are on that track. It's incredibly rewarding, it takes up a lot of your time. So you do want to do it as something you actually truly love. And it's hard to make that decision because before you go to med school you don’t really know what you're getting into. We always encourage people to try to shadow doctors in the hospital, in different parts of the hospital, to get a sense of whether they like being around patients and like being in the hospital, but that's still not a complete picture. It's also helpful to explore other things -- a lot of med schools look for research experience, and a lot of people realize they like research and stay with that. Or if you like research and you like medicine, you'll find the MD-PhD program will make sense.

I think that it's a little bit of a leap of faith because you don't really know exactly what you're getting into until you start, but talking to people who are at different levels of training, shadowing at the hospital, and doing research is important too, to get a sense of whether you're interested in the medical questions that you would face as a doctor and whether you want to have direct interaction with patients. Because there are other ways you can advance medicine that don't require you to go to med school. If you are designing instruments that you are using in the operating room, or you can be a physician assistant -- there are fields I didn't know about when I was coming through college. There are other ways you can provide care for patients and be in the medical field. So you have to try to do as much as possible to get exposure and see if there's something that clicks. I think the more opportunities that you create for yourself and the more you expose yourself to parts of medicine, the easier it’ll be for you to make that decision.