As 2013 closed, I received an invitation from ASCO to become a mentor in their International Development and Education Award (IDEA) program. As is the case when it comes to ASCO, I reacted just like Pavlov’s dog and said yes before learning what I was agreeing to (note to self—might want to work on that). However, after reading about the IDEA program, I was more than honored to be a part of it. After all, I am originally from the South Pacific, and international efforts to improve medical care have long been of interest to me. I filled out the requisite paperwork and promptly forgot about it (note to self—probably a good idea to remember my commitments.)
Forward to March 2014 and another email letting me know that I had been assigned a physician as part of the IDEA program, Dr. Iryna Muryzina. I learned she is from Ukraine where she works as an Assistant Professor in Obstetrics-Gynecology at Kharkiv National Medical University, and that her interests are in gynecologic oncology and the prevention of gynecologic cancers. I wondered how best to show her the practice of gynecologic oncology and realized quickly that her experience would be enriched by demonstrating how interdisciplinary gynecologic cancer care is delivered.
To that end, I invited my friend and colleague at Massachusetts General Hospital (MGH) Cancer Center, Dr. David Boruta, to join me as a co-mentor. “Sounds great,” Dave said. “I’d be happy to help. I’m probably in clinic that Thursday and Friday, but happy to have her with me and help to show her MGH.”
Together we made contact with Dr. Muryzina, secured her ability to observe in clinic and in the operating rooms, and prepared to meet her.
I met Iryna at the 2014 Annual Meeting and was immediately drawn to her enthusiasm and passion to see and learn. I introduced her to my colleagues from Boston, asked her to attend an educational session on gynecologic cancer, and confirmed our plans once she arrived in Boston. She required little hand-holding and immersed herself in the activities of the Annual Meeting.
At my session on gynecologic cancer survivorship, I was happy to see Iryna in the audience. After my session, where I spoke of sexual health, Iryna told me she had not heard of the attention to survivorship issues after cancer, as it is encouraged by ASCO, and found the discussions that day to be eye-opening. “In my country there is no established practice for psychological aid and consulting women with regard to their emotional and sexual difficulties after cancer treatment,” she said.
Once she got to Boston, we met at MGH and went to our multidisciplinary tumor board conference, where she also met Dave. At Tumor Board, we do what we do normally—review histories, look at pathology, and discuss treatment plans. As par for the course, discussions that day were “spirited” as each of us reviewed data and evidence.
Afterwards, I asked Iryna what she was most surprised by, and she answered: “I find it is remarkable to have the participation of a pathologist who actually brings up representative slides of the tumor, including equivocal and suggestive sites of disease.”
Following Tumor Board, she shadowed David Boruta, and I asked him to share his experiences. He wrote: “After meeting her at Tumor Board, we saw consults on that first day, but beyond gaining an understanding of medical training and health-care delivery in Ukraine, Iryna shared a wealth of cultural insight into the current conflict in her country. I learned about her experience growing up in the former Soviet Union and how that informs her current practice as well as structures her hopes for the future within Ukraine, both generally and in terms of medicine. On her second day in Boston, Iryna came to the operating room with me. My surgeries utilized a laparoendoscopic single-site surgical approach, which required one small umbilical incision. After that, I brought her to a partner’s robotic-assisted laparoscopic procedure, where she got to sit at the console and look through the robot’s binocular-like lenses. Her reaction to the three-dimensional image before her was one of astonishment. Although I enjoyed exposing her to our ‘sophisticated’ (a.k.a. expensive) technology and approaches, I could not stop thinking about what she and her colleagues accomplish every day in Ukraine—in a setting with far less resources than my own. As we discussed this, it was apparent that the limited availability of formal medical and surgical teaching in Ukraine was of far greater concern than the paucity of high-tech surgical equipment. As such, she was very interested in observing and understanding the structure of our training program. She observed the interaction of trainees, including medical students, residents, and fellows, with attending physicians across disciplines.”
On her third and final day in Boston, Iryna and I got to work together. That morning, I asked her to share her experiences with Dave and the gynecologic oncology service. She wrote:
“I am involved in teaching students and working out educational programs regarding obstetrics and gynaecology, including gynaecologic oncology. I think that in my country, there has been a lack of attention to the necessities that would improve resident education, motivate doctors to do their work properly, and enable the acquiring of new skills and knowledge. I had not seen the surgery techniques Dr. Boruta showed me, so it was quite an interesting experience. Talking with Dr. Boruta about their advantages and disadvantages from my perspective was also eye-opening.
I think in my country, we should take into practice this trend towards increased use of minimally invasive surgery. Right now, it constitutes only up to 10% of all the surgeries performed in gynaecologic oncology in Ukraine and is almost restricted to bilateral salpingo-oophorectomies indicated for the treatment of breast cancer. Most women who require a radical surgery still undergo open laparotomy. Furthermore, despite having experienced surgeons in gynaecologic oncology units across my country, we still involve a general surgeon if the resection will be extensive as in cases with significant bowel, liver, spleen, diaphragm, and peritoneum involvement. It was amazing to see that at the MGH, gynaecologic oncologists do the entire procedure on their own.
Finally, I was impressed by the well-organized multistep workflow that allows the residents and fellows to master the skills for office practice (diagnosis, management, treatment, etc.), surgery, and clinical research—all with an emphasis on the importance of teamwork.”
On that last day, we saw patients in my sexual health clinic, which was a new experience for Iryna. She commented that this was an area of cancer care not practiced in Ukraine, and she immersed herself in visits, engaging with my patients and even offering some advice from her own perspective. Afterwards, we talked about survivorship, palliative care, and symptomatic management in patients with cancer. Her following thoughts on the topic made me realize just how important the IDEA program is:
“At MGH, there is such attention to the restoration of the woman's needs and requirements after cancer treatment (intimate relationship, family, maternal duties, professional capacities). In my country, there is no established practice for psychological aid and consulting women with regard to their emotional and sexual difficulties after cancer treatment; palliative care is rendered in a scrappy and scattered way. It made me realize how important it is to provide this access to patients and how much our own patients deserve it.”
It will be experiences like this one that set new standards in cancer care worldwide. Far from the demonstration of new techniques and access to personalized therapies, attention to the patient with cancer is important, perhaps as important as the cancer itself. There are parts of the world where this notion has not yet been embraced, but after seeing the possibilities widen for Iryna about what can be possible for her own patients, I have come to believe that ASCO’s IDEA program will be an important vehicle to progress.
As we said goodbye that Friday afternoon, plans were made for a continued mentorship, perhaps to bring survivorship care to Ukraine. Iryna wanted to share these final thoughts about the IDEA program and MGH:
“I found it impressive that my mentors had a genuine interest in my experience in Boston. This was unusual for me, especially since there remains a certain hierarchy in medical education such that attendings of higher ranks generally do not pay much attention to observers or students. The mutual respect and collegiality among oncologists was apparent at ASCO, and it was refreshing to see that same spirit of collaboration at MGH, irrespective of academic rank. I was also struck by the familiarity among the attendings (especially among my mentors), and between attendings and their residents. I was amazed to see the use of humor in medical education, which I could see having a positive impact on students, residents, and fellows. In my country, this level and type of interaction is not common among professors and was an eye-opening observation for me. I thank ASCO and my mentors for the opportunity and am grateful for this experience, which I think will be very useful for me and my students without fail.”
Even with Iryna’s kind words, as I look back now, I think we learned as much, if not more, from hosting her. I believe Dave reflected best the experience we shared: “When our short time together was over, I’m not sure who of us gained the most; we all came out of the experience with a richer understanding of what it means to care for women with gynecologic cancers and the common challenges we face.”
Caption: Dr. Dizon with Dr. Iryna Muryzina, at the 2014 ASCO Annual Meeting, 5/31/2014