East magazine Winter 2009
From the Classrom

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Training vascular surgeons to have a heart

By Leanne E. Smith

When he was 15, Steven Powell got a job as an orderly at his hometown hospital in Kentucky. He watched doctors whose skill and dedication inspired him to attend medical school. Thirty years after receiving his M.D. with distinction from the University of Kentucky, a visual reminder of his beginnings in medicine decorates his office wall: a shadowbox containing the mask and gloves from his first scrub.

As chief of vascular surgery at the Brody School of Medicine since 1989, Powell has inspired a generation of medical students. “When I get in a difficult spot, I think about how he would manage the problem,” says Dr. Philip Brown ’95, who practices in Wilmington. “For all of us Powell ‘disciples,’ in the back if our minds, there’s a little Powell there telling us how to manage it. That’s something that makes someone a superb educator.”

Powell downplays the accolades, but his colleagues still praise him. Powell is “unique as a leader and surgeon,” says Dr. W. Randolph Chitwood Jr., chief of cardiothoracic surgery and director of the East Carolina Heart Institute. Colleagues point out that Powell has authored more than 40 publications, delivered more than 20 conference presentations and held academic committee assignments. He’s served as vascular section editor for the scholarly journal Current Surgery since 1990. A member of more than 25 professional organizations, he co-founded the Carolina Vascular Society in 1994. Several times, Business North Carolina magazine has named him one of the “Best Doctors” in North Carolina.

BSOM students admire him and seek his advice. Powell helps facilitate mock oral exams and delivers guest lectures. Several times, fourth-year medical students have selected him to deliver a portion of the annual String of Pearls address, during which a few medical faculty offer their “pearls” of wisdom.

The primary lesson he wants students and residents to learn is “to do what is in the best interest of the patient and try not to do too much or too little.” The balance is rooted in the style he learned as a teenager: focus on team effort and education with doctor–resident, doctor–doctor, and doctor–patient partnerships.

Taking the team approach

In the “great teaching lab” environment of the operating room, Powell and his team—Drs. William M. Bogey Jr., Frank M. Parker, and Michael Clinton Stoner—primarily mentor third- and fourth-year medical and physician assistant students. While many of the residents with whom Powell works focus on general surgery, some specialize in vascular training. With the opening of the new Heart Institute, however, Powell says, “One of the goals is to have our own specialized training program in vascular surgery.”

Then, he says, more doctors and their patients would know that cardiovascular disease isn’t just about heart attacks and strokes. The same plaque buildup that can reduce or totally block blood flow to the heart and brain also can clog arteries that supply blood to other organs, arms, and legs. Such blockages—known as peripheral arterial disease (PAD)—reduce a patient’s quality of life and can eventually cause heart attacks and strokes.

Whether students choose a vascular path or not, Powell says supervising doctors are proud of their apprentices’ progress at different points. “Sometimes a resident or student will show such self motivation or accomplishment that in the short run there is immediate pride in what they accomplish. Other times, it is at the culmination of six years of training and feeling they are ready to practice independently as conscientious surgeons.”

Teaching and learning don’t stop with the doctor–resident team. Powell believes “There is not enough time devoted to teaching about vascular disease in medical school,” and as a result, “Some doctors perform too many procedures because they fail to keep up or have knowledge of the latest medical advances, which can in many cases avoid expensive, invasive treatment like surgery, or an angioplasty or stent procedure. If we can save patients from having one too many expensive tests or procedures, then we can go a long way in helping solve the financial crisis that is reaching the boiling point in our health care system.”

Powell and his team want new and experienced doctors, even outside a university setting, to be aware of current research and practice. He has given numerous guest lectures for professionals at satellite locations of the Eastern Area Health Education Center, and facilitated outreach clinics in several eastern N.C. counties. He hopes his quartet of “experts in cost-effective diagnosis and treatment of PAD” can continue to “share knowledge with other providers who cannot be as up to date with the latest developments in diagnosis and treatment of vascular disease.”
Treating PAD, he says, shouldn’t just be about a doctor prescribing a drug or performing a surgical procedure. In fact, surgery should rarely be the first solution. Long-term PAD management requires patients to control risk factors: don’t smoke; exercise regularly; maintain a healthy diet; and regulate diabetes, high blood pressure and high cholesterol.

The noninvasive treatment approach has been successful. Chitwood says, “He has developed a world class vascular surgery program at ECU with world class surgeons, who specialize in the least invasive procedures and operations for both complex and simple blood vessel disease and stroke prevention.”

Learning permeates life

Powell’s multifaceted perspective on medicine carries over into his life away from campus. He enjoys “golf, capitalism and the financial markets, all aspects of American history, fly fishing, C-SPAN’s Book TV, cosmology, horses, writing and education.” His recent reads include Founding Brothers: The Revolutionary Generation and The Last Lecture.

On or off campus, learning permeates Powell’s life. He and his team look forward to the educational opportunities in the new Heart Institute that will help them add members to the team of doctors, students and patients who put patient health first. “In addition to our commitment to educate the doctors of the future through our affiliation with BSOM and Pitt County Memorial Hospital, the new center offers a chance to implement a system of cost effective, total care of all aspects of the treatment of cardiovascular disease and to develop a support network for education of primary care providers who are dealing with patients with vascular disease in our region and beyond.”

“He’s a character, and his charisma inspired us,” says former pupil Brown, who practices with Wilmington Health Associates. “He’s a fabulous mentor, always available for advice. He’s an extremely gifted surgeon and enjoys what he does, whether it’s teaching or surgery, and Powell is a large part of the reason why I decided to go into vascular surgery. He challenged us to develop mastery over vascular disease treatment. He’s passionate about doing the right thing and really conveys that to his trainees.”