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Hitting the right note with medical learners

Toronto, September 5, 2019

By Emily Dawson

Drs. Eliane Shore and Lauren Jain work with residents in the Allan Waters Family Simulation Centre to help them learn the Over the Rainbow technique
Drs. Eliane Shore and Lauren Jain work with residents in the Allan Waters Family Simulation Centre to help them learn the Over the Rainbow technique. L-R: Dr. Haniya Khan; Dr. Sarah Hampson; Dr. Lauren Jain; Dr. Eliane Shore; Dr. Sam Benlolo. (Photos by Katie Cooper)

“Somewhere over the rainbow,
Way up high,
And the dreams that you dream of,
Once in a lullaby.”

Over the Rainbow. It’s a tune you’ve likely heard before and perhaps found yourself humming as you read the lyrics. These days, you may even find St. Michael’s Hospital obstetrics-gynecology residents singing it in the operating room.

Dr. Eliane Shore, staff obstetrician/gynecologist at St. Michael’s and an assistant professor at the University of Toronto, uses the song to teach OB-GYN residents to tie intracorporeal knots for sutures during laparoscopic surgery. She coined it the “Over the Rainbow technique” — because of how the technique calls for using rainbow-shaped movements — and it’s helping residents and fellows learn an intimidating skill.

Dr. Shore has been teaching a laparoscopy course for first-year residents for six years. Laparascopy is minimally-invasive surgery that uses tubes inserted through small incisions in the body. Surgeons place a video camera and instruments through the tubes to perform the operation.

“To effectively teach knot tying on the sutures, I had to become really good at it myself. I started watching a bunch of videos that used different techniques and this is where I got the idea for Over the Rainbow,” said Dr. Shore.

The Over the Rainbow technique simplifies a complex skill in gynecological surgery. As Dr. Shore and countless residents have found over the years, there are numerous methods to use for intracorporeal knot tying, many of which can be confusing to learners.

“On the first day of the course, I ask students to try to tie a knot before showing them the Over the Rainbow technique. Nobody can do it on Day 1, but by the sixth week, they are able to do it in under 10 minutes, which is the standard we aim for,” said Dr. Shore.

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In the Simulation Centre, each resident has a station to practice intracorporeal knot tying.
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Dr. Sam Benlolo practices intracorporeal knot tying after reviewing Over the Rainbow technique with Dr. Shore.
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Dr. Lauren Jain (L) collaborated with Dr. Shore to make an educational video about the Over the Rainbow technique.

Learners often tell Dr. Shore how much they appreciate the technique and she started hearing more and more students singing the song in the operating rooms.

“It’s a fun and catchy way to learn and it sticks with people.”

Dr. Lauren Jain was Dr. Shore’s fellow when she first learned about Over the Rainbow.

“In residency, we rotate through so many hospitals and we learn different ways of doing one thing. It gets confusing if you only have one opportunity to practice it each time,” said Dr. Jain.

“Because knot tying includes a sharp object inside the body, it’s nerve-wracking and can create high stress. When Dr. Shore presented this technique, it was just so intuitive, simple and easily reproducible.”

Dr. Jain, who is now a staff physician at St. Joseph’s Health Centre, was so impressed by Dr. Shore’s teaching that she decided to collaborate with her and make a video which included practicing the technique in the St. Michael’s simulation centre and then completing a knot tie on a real patient. Dr. Jain then animated the video with rainbow graphics to reinforce the directions and accompanied it with two versions of the famous tune.

“Hearing students break out in song in the operating rooms makes it less intimidating to practice and more memorable to learn,” said Dr. Jain.

Dr. Jain recently presented the video at the Society of Obstetricians and Gynaecologists of Canada conference. She’ll also be using the video to teach her own students and hopes to find ways to continue sharing it within the broader OB-GYN community.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.


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