Popular media tells us that surgeons are taught their chops (Boom-tish!) by being thrown in the deep end – surgery without supervision. Or that somehow medical school gives you the skill/knowledge/preparation to magically “guess” how to do a procedure.
In real life you have to be taught things. There’s a whole physical language that goes along with surgery. We sew things together using half-circle needles, using tongs. Our scissors are curved and we care how long they are. We sometimes use three different shaped scalpels in one case, and get precious about which one for which task. We tie knots in string in a particular way, for goodness sake.
All of this pedantry takes time to learn. The classic adage is “See one, do one, teach one” but my experience of learning surgery is different. More like, “See three or four, do a small portion of three, progress to doing most of two more, do something stupid, then watch some politely until you can be trusted not to be stupid.”. This goes on for a while.
At the start of the year I couldn’t amputate a leg. I watched a few. I did a few very closely supervised (Cut on this line. Now divide this. Tie off those vessels. No! Use 3/0! Etc). I did a few more loosely supervised, where I was calling the shots, but with the surgeon still scrubbed.
Finally, this week my boss quietly asked me if I felt ready to do one with the resident, while he sat in the next room. This is a big step. It means he trusts me to judge my readiness. It means he felt I was good enough to manage it without anyone giving me instruction. And I was. And I did.
I got the biggest shot in the arm from that. It basically means I am able to do that procedure, with some support. Which means (in my mind) that I am now qualified to be on M*A*S*H.
I know it’s not a terribly logical leap, but since I was a kid I watched these smart doctors do amazing things like amputate legs. Apart from the bad moonshine, serial relationships and gurney races, I am now one of those doctors. I’m living my simplistic childhood dream.
When i had my first baby, things went a bit crazy and the ob flicked out this massive roll of scissors and tools. I couldn’t believe he had so many, and were was he hiding those before.
Anyway, he got to use his tools of choice and seemed to be making a patchwork quilt by the end! At least now I know he needed different tools for each thing he was doing!!
Congrats, DrCris.