BLOG: Teaching renews sense of mission, purpose

I have been blessed to have spent my entire career in academic medicine.

This immersion in academia has afforded me the opportunity to remain current with contemporary research and cutting-edge technologies. In addition, spending my days with residents and fellows truly has kept me “young at heart.” As I enter the final chapter of my vocation, I have come to recognize the true benefits of being afforded a position to teach and mentor – the opportunity to find real purpose and meaning.

Many of us may succumb to the egoic rush that “professing” a technique or principle may engender. Others may delight in the privilege of being “needed” by others. However, when we recognize the quantum good we can generate in passing knowledge to the next generation, a new sense of purpose and meaning will manifest. And yes, burnout will be held at bay.

Pay it forward

When we invest in the training and formation of our next generation of surgeons, we are powerfully giving back to our beloved vocation and investing in a service to mankind with exponential returns. After 34 years of practical experience, I pretty much know every failure path imaginable. I am eager to share my hard-earned wisdom with trainees in hopes of improving quality of care and sparing future patients any anguish my mistakes may have caused.

I trust that the fellows and chief residents I have been blessed to train will convey their knowledge to their junior residents. The effect compounds as each “pearl” gets handed down generation to generation. If the average orthopedic surgeon performs 360 cases per year, then this would translate to nearly 11,000 cases for a 30-year career. Imagine the cumulative effect of just a few surgical pearls relayed to just one surgeon.

For more than 20 years, I have shared with our residents and fellows a highly effective method of performing margin convergence of rotator cuff tears taught to me by my close friend Felix “Buddy” Savoie, MD. Countless patients have benefitted from a singular trick of the trade imparted to me in 2001 that has been passed down the educational ranks.

John W. Lachman, MD

I was privileged to study under John W. Lachman, MD, former chairman of orthopedics at Temple University and fabled surgeon and educator. Lachman essentially consecrated his life to training residents. Not only did Lachman school his disciples in surgical techniques, he was resolute in graduating residents well trained in ethics, professionalism and life management. Lachman’s influence resulted in a bounty of competent, honorable and personally fulfilled surgeons. His teachings had such a profound effect on generations of surgeons and families that his name is still venerated in the halls of Temple University Hospital decades after his passing because of all the good he effected.

To say that Lachman lived a purpose-driven life is an understatement. His teaching was the epitome of “force multiplier,” and he forfeited much income and even fame in exchange for a deeply fulfilling and meaningful life.

Surgery is not a spectator sport

We may be deluded into thinking our trainees can learn well merely by observing, but the act of surgery, like any other skill, can only be honed with practice. The 80-hour work week has created a moral imperative to maximize learning for our residents. If we intend to train competent surgeons, they can only learn with deliberate and supervised practice.

Knowing how much to allow each trainee to perform is indeed a skill, honed by years of trial and error. I find generous communication with the trainee to be very helpful before the case. This “presurgical briefing” delineates what I expect the trainee to perform and where I am likely to intervene. This sets expectations and diffuses confusion as to roles and goals.

Increased time is worth it

We all recognize that teaching increases surgical times, but economic pressures have resulted in a reduction in time devoted to surgical teaching. However, well-conceived and prepared supervision can result in excellent surgical outcomes. In addition, residents more engaged in the direct care of patients will tend to invest more time in both preoperative and postoperative care.

Nine-tenths of education is encouragement

In our performance-driven and hypercompetitive educational arena, I find there is an “affirmation void” in our training scheme. I believe proper surgical execution cannot be attained without some measure of confidence. Appropriate and specific positive feedback can help transform a trainee’s competence by increasing confidence. Constructive criticism should be carefully levied and delivered truthfully, compassionately and devoid of any shame-based flavor.

We are called to expect excellence, not perfection, and instruction should always be conveyed with the intent to increase, not undermine, one’s capabilities.

To teach once is to learn twice

Teaching has certainly improved my surgical acumen. I need to have mastered all the steps of a surgery to teach effectively. If I stumble during any steps of execution, then I have simply not prepared effectively. I have also humbly learned new perspectives and innovations from my students. Just when I think I have it all figured out, a resident or fellow will suggest a novel, alternative approach to a surgical problem. The continual quest for improvement must be shared by pupil and teacher alike.

Recalibrate your mission

If you are in an academic setting, renew your vow to train the next generation of surgeons. If you are in private practice, actively seek out means to educate young men and women in training. You may see a small decline in efficiency and income, but you will have discovered a renewed sense of mission and purpose. You will leave the workplace knowing you are making a sizable impact on the health and well-being of patients you will never meet.

References:

Bohnen JD, et al. J Surg Educ. 2021;doi:10.1016/j.jsurg.2020.06.029.

Vinden C, et al. Can J Surg. 2016;doi:10.1503/cjs.017515.

For more information:

John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania and can be reached at john.kelly@pennmedicine.upenn.edu.