Life Long Learning

In a field of medicine such as hand surgery, although some fundamental entities stay the same (pathology, anatomy, etc), there are inevitable changes and advancements as time passes.  Even if the underlying anatomy remains unchanged, a surgical approach may be refined over time to hopefully improve outcomes and minimize time and risk. New technology and implants are constantly being proposed, trialed and either adopted or precipitously retired. This perpetual change is likely part of the reason that medicine is an attractive field, as there is always an opportunity for new concepts and learning.

As I reviewed medical student applications for residency this year, I saw the phrase “life-long learner” in multiple personal statements. Residency and fellowship are times in which you are drinking from the proverbial fire hose as a trainee. Ideally, the learning continues, albeit at a less steep slope, as we begin and continue our practices. How do we ensure that we, and our colleagues, are keeping up with the times? Certainly our recertification processes are geared towards keeping our knowledge base up to date. Journal subscriptions, courses and annual meetings are integral in this process. The requirement of CME credits for MOC purposes may serve as the nudge necessary to encourage participation.

We take self-assessment exams to evaluate the maintenance of our medical knowledge. But, the operative component of our practices is rarely targeted for evaluation and possible improvement.  There is no formal direct evaluation of our surgical technique beyond our residencies and fellowships and no indirect evaluation past board certification. Certainly the first few years of practice are a steep learning curve in terms of patient care and refinement of surgical skills. But, this is mainly a process of self-critique.

I distinctly remember a case in fellowship in which two Attendings scrubbed together as one had more experience with the particular procedure and the other hoped to hone their skills by being guided by the more experienced surgeon. This can be challenging in practice due to schedules and egos. In this particular case, it was not a formal evaluation process, simply taking advantage of an opportunity to enhance one surgeon’s knowledge and skills. However, we would likely all benefit from having a partner scrub with us even on the most common cases to constructively critique our technique and potentially our behavior in the operative setting. Once you have established a routine in practice, it can be hard to see outside that bubble. This is true of both pure surgical technique and in terms of operating room and team efficiency, but there is always room for learning and improvement.

I have the benefit of working in an academic center with multiple partners, each with unique training and skill sets. This lends itself to the opportunity to scrub together on cases in which you are hoping to learn from each other’s experience. However, I think we would all potentially benefit from doing this on a semi-regular basis and not just for “challenging” or “unique” cases.

As surgeons we strive to provide the best care for our patients, which requires us to evolve as physicians over the course of our careers. Learning from our colleagues can take on many different forms – both didactic and hands-on. Regardless of the stage in our personal careers, we might all benefit from reevaluation and reflection long after formal surgical training has been completed.

Article written by:

Dr. Fishman is a hand and upper extremity surgeon at Loyola and the Shriners hospital in Chicago, Illinois. Her academic interests include pediatric/congenital upper extremity, brachial plexus and tetraplegia. Away from the hospital, she enjoys running, avidly following Duke basketball and all Boston sports teams.

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