Andrew Jensen, MD, MBE | Elizabeth Dennis, MD | Cory Smith, MD
June 24, 2020
A quick Google search will reveal that there are thousands of quotes about practice. My favorite, however, is from Allen Iverson who, when asked a question from a reporter concerning that day’s practice, infamously responded, “We’re talking about practice. We ain’t talking about the game. We’re talking about practice, man.” Yes we are indeed “talking about practice” today and how to effectively practice to improve our surgical skills. It can be difficult for residents to learn surgical skills needed strictly in the OR between work hour limitations, operating room time and budget concerns, and patient safety. Most recently, the COVID pandemic has more than ever forced us to think creatively about ways to train residents without the opportunity to interact with patients. Let’s discuss a few old and new ways that all of us can maximize our brief five years of training to fill our toolbox and sharpen our skills before beginning our practice.
1Plan, Plan, Plan
Perhaps the most important portion of every surgery is everything that leads up to the actual procedure. Ensure that preoperatively you grasp the goals of the operation, the steps of the procedure, but most importantly the anatomy. A seasoned surgeon once told me Orthopedics is “anatomy, anatomy, anatomy, and the other stuff”. Younger residents may also want to take time with older residents or attendings to ensure that they know how to create a preoperative plan. There are innumerable resources that can help you with preoperative planning, one of which is the AAOS Orthopedic Video Theatre (OVT) with many peer-reviewed surgical videos including commentary from the primary surgeon. Finally, one of the best ways to preoperatively plan for an operation as a resident is to discuss the plan with your attending. A brief conversation cannot only help you prepare well, but signals to the attending that you are appropriately prepared and ready to take the knife. Remember those who fail to plan are planning to fail.
2Outside the Box
As mentioned previously, work hour limitations have created artificially lower boundaries on resident’s operative cases. However, innovations have developed to enhance surgical skills outside the OR setting. Surgical simulators have improved dramatically over the past decade and their efficacy has been validated in multiple peer-reviewed studies. Challenges with simulators, however, include cost, real-life translational capability, and poor durable skill training. Recent advances in virtual reality are creating an exciting new platform by which residents and fellows may be able to achieve more sustainable skills with streamlined devices. As residents, we should be clamoring for opportunities to use these new innovations when not performing our clinical responsibilities. There will also be opportunities to use cadaver labs supported both from your institution and industry. Time in the lab can improve your dexterity and surgical skills, but these labs can also deepen your understanding of the surgical anatomy in a less-pressured environment.
3The Mind is a Terrible Thing to Waste
As residents, we often spend the majority of our time working on our hand/eye coordination, using tools, and the physical portions of a case. However, we must not neglect the most effective weapon in surgery – our mind. Over the last decade, there has been an explosion of research in fields from surgery to professional sports showing the benefit of mental repetition or rehearsal on performance. After the surgical plan has been created, take time before every operation to mentally rehearse the steps, navigate the anatomy, and anticipate potential problems. If you find the actual operation not resembling your mental rehearsal, you may be able to prevent an avoidable mistake. You will also find this improves your confidence in your ability even if you are doing a task for the first time. The final step is learning to clear your mind before any operation. Residency can be hectic dealing with patient care and day-to-day tasks on top of learning surgery. Meditation can be an effective way to learn to clear your mind and restore your focus before each operation. There are now many apps and internet resources offering meditation classes and sessions that are performed daily or a few times per week that may help you clear your mind and focus throughout the day.
Improvement in surgery is oftentimes like a road trip. You make slow and steady progress focusing on each mile and each day as you go, and only when you arrive can you realize how far you have traveled. However, in order to continue to move forward we must treat this as a vocation or calling and not just a job, and we must practice tirelessly both at and outside of work to improve. After all, if we’re talking about medicine, “we’re talking about practice”.
DISCLOSURES: Dr. Dennis This individual reported nothing to disclose Dr. Jensen AAOS: Board or committee member Dr. Smith This individual reported nothing to disclose.
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