“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Sunday, July 1, 2007

It is hard to wear other people's shoes .... especially if they are not my style

“Learn from yesterday, live for today, hope for tomorrow.”
~Albert Einstein

Over the last few weeks, I have been reading a number of articles on several different topics that are pertinent to training and residency. In my reading, I have found that there are many others who have had similar thoughts to my own. Training in the 21st century is very different from when Halstead, the father of modern surgical training, instituted the changes which are the foundations of many surgical residencies today. Halstead believed that the content of surgical training should be well defined and that surgeons should be taught, above all, to think. Halstead also believed that research should be part of surgical training. Dr. Cushing, a student of Halstead, once wrote "the physician requires a special combination of head and heart; the surgeon of head, heart and hand- a rarer combination which comes partly by gift and partly by training."
The best surgeons are those who make the best decisions. Excellence in surgery begins with disciplined thinking and sound clinical judgment. These are rooted in a thorough understanding of pathophysiology, and a deep knowledge of the basic sciences. Familiarity with scientific research is important because surgeons must understand how to interpret scientific data in order to inform their clinical decisions.

For the surgeon, the heart is separated into three separate but equally important components.

  • Compassion is what causes a surgeon to make patient care his or her first priority, regardless of personal convenience. Compassion is the impetus behind long house on the wards or in the laboratory. Compassion is what inspires surgeons to donate their services when patients cannot afford to pay.
  • A surgeon's heart must be resilient so that he or she can persist in the face of setbacks.
  • And a surgeon's heart must be courageous, to allow him or her to carry out procedures that entail significant risk.

Cushing envisioned technical excellence involving a solitary surgeon laboring to perfect specific manual tasks. Surgical outcomes depend on making an entire process smooth, from patient transport and room turnover, to having the proper surgical instruments in the operating room. This is accomplished through teamwork. Thus, the hands of the team, working toward a common goal, are more important than those of an individual.
Halstead's training program was one of progressive responsibility. It consisted of an internship period (the length was left undefined and individuals advanced once Halsted believed they were ready for the next level of training). Internship was followed by 6 years as assistant resident and then 2 years as house surgeon. In the training of surgical residents, this training technique with its long hours has come under fire over the last few years. At the time when most of these changes where made, this field consisted primarily of white men. There was very little diversity at the time. Therefore, those who made the rules had a similar perspective to those for who the rules where made.

Over the past few decades, medicine has become very diversified and with diversification comes different perspective. When there are differences in perspective, there can be conflict because of not understanding the foundations of a persons driving force, or what is important to that individual, the cognitive perspective. The cognitive perspective is a internal set mental processes, such as creativity, perception, thinking, problem solving, memory, and language. This perspective is effected by underlying up bringing, moral values, and experiences. This is one of the reasons there are many differences of opinion on many topics. This especially comes into play when discussing these new changes in medicine and medical training.

I have posted previously on generations and generation differences in an effort to understand the other's perspective. From what point of view are you seeing things? What is the learner's value system? I think that in order for an educator to better educate, he/she must understand the learner's point of view. This post is a prelude to 2 separate series I will post in the future. Both are very much effected by your perspective. The first series will be on professionalism. This has been brought up by some people who have commented on my blog and I have seen this discussed on several different forums. It has also been in the mainstream media and under government scrutiny. The second series will be on leadership. Our own academy has put out some different guides to professionalisms as well. So, I think that this will be a fitting series of posts for those at the beginnings of their careers in orthopaedics or any surgical specialty for that matter. When I write on these topics, it will be from my perspective, but I will try to remove some of my own prejudices and blinders. I invite people to comment on these topics so that a different perspective can be brought into the mix.

“If you can't explain it simply, you don't understand it well enough”
~Albert Einstein

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