Modern Surgical Mentorship: Evolving Training for the Next Generation of Surgeons

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• Surgical Mentorship Evolution
• Accountability in Surgical Education
• Millennial Feedback Dilemma
• Mastery Through Anatomical Study
• Legacy of Surgical Education
• Full Transcript

Surgical Mentorship Evolution

Dr. Philip Theodosopoulos, MD, describes a fundamental shift in surgical training philosophy. The traditional model relied on learning through osmosis. Residents were expected to absorb skills and knowledge indirectly. This often placed the burden of failure solely on the trainee. Dr. Philip Theodosopoulos, MD, explains this outdated approach to Dr. Anton Titov, MD. He notes it was historically difficult to prove a professor was an ineffective teacher.

The modern paradigm demands structured, intentional education. This new system moves away from passive observation. It requires active, engaged teaching from senior surgeons. The goal is to create a more reliable and transparent training process.

Accountability in Surgical Education

A cornerstone of modern surgical training is instructor accountability. Dr. Philip Theodosopoulos, MD, highlights initiatives that formalize this responsibility. These include requiring residents to perform observed, adjudicated surgeries. Faculty members must directly evaluate a resident's technical performance.

Another key initiative is the mid-point written evaluation during rotations. This provides actionable feedback while there is still time for improvement. Dr. Theodosopoulos tells Dr. Anton Titov, MD, that this makes evaluators accountable for outcomes. It answers a critical question for the public: who verified a surgeon's competence?

Millennial Feedback Dilemma

The millennial generation of surgical residents seeks constant, immediate feedback. Dr. Philip Theodosopoulos, MD, acknowledges this generational shift in learning styles. He sees value in this approach, as it prevents residents from being surprised by end-of-rotation critiques.

However, Dr. Theodosopoulos also identifies a significant drawback. An over-reliance on immediate feedback can hinder the development of independence. It risks shifting responsibility for performance from the resident to the teacher. This contrasts with older generations who assumed everything they did was wrong unless told otherwise. Dr. Anton Titov, MD, discusses this nuanced challenge in training the next generation of surgeons.

Mastery Through Anatomical Study

Achieving surgical excellence requires immense dedication to foundational knowledge. Dr. Philip Theodosopoulos, MD, offers crucial advice to young neurosurgeons. He advocates for the "10,000-hour rule" applied to one's surgical subject.

For a neurosurgeon, this means spending 10,000 hours in dedicated study of the brain and skull. This deep, immersive anatomical study is non-negotiable for mastery. Dr. Philip Theodosopoulos, MD, emphasizes that learning dissection anatomy makes every surgeon better. This commitment forms the bedrock of technical skill and clinical judgment.

Legacy of Surgical Education

The ultimate purpose of surgical mentorship is to ensure a legacy of excellent patient care. Dr. Philip Theodosopoulos, MD, expresses a profound drive to pass on knowledge. He believes a surgeon's true genius is not in what they know, but in what they can teach others.

This philosophy is central to the life of an academic surgeon. The goal is for future generations to surpass their teachers. Dr. Theodosopoulos tells Dr. Anton Titov, MD, that he wants to be made obsolete by his trainees. This ensures continuous improvement in surgical techniques and patient outcomes for years to come.

Full Transcript

Dr. Anton Titov, MD: Surgical mentoring is a key task for all leading neurosurgeons. "The genius within is the genius that you can pass on," a leading neurological surgeon advises. "You are not a genius until you can transfer your genius to the new generation."

To become a leading surgeon, you have to spend 10,000 hours alone with your study subject. For neurosurgeons, the subject of the study is the brain and skull. Spend 10,000 hours alone within your surgical subject.

Advice to young neurosurgeons: surgical mentoring.

Dr. Philip Theodosopoulos, MD: Modern education in surgery requires a change from old surgeon mentorship to structured educator treatment. Feedback to trainee surgeons has to happen more often. Millennial generation surgeons require constant feedback.

This is not good for fostering independence and self-reliance in a surgeon. Millennial generation surgeons seek immediate feedback. It is important for the public to know who stamped that a surgeon can do this or that surgical operation well.

Dr. Anton Titov, MD: How to become the best surgeon?

Dr. Philip Theodosopoulos, MD: Study the anatomy of your chosen surgical specialty. Devote 10,000 hours one-to-one with your study subject. For a neurosurgeon, the study subject is the skull and brain.

Learning anatomy and studying dissection anatomy makes every surgeon a much better surgeon, the best surgeon. The genius within is the genius that you can pass on.

Dr. Anton Titov, MD: A medical second opinion from a leading surgeon can confirm that a diagnosis is correct and complete. A medical second opinion also helps to choose the best treatment for any surgical problem, such as a tumor, heart surgery, or trauma.

Dr. Philip Theodosopoulos, MD: Seek a medical second opinion from an independent expert and be confident that your treatment is the best.

Dr. Anton Titov, MD: And patients quote two specific things that you have done in the neurosurgery residency program.

First is the requirement that each resident perform two observed adjudicated surgeries before a faculty member each year. The second initiative involved mid-point written evaluations during each four-month rotation that your surgical resident completes.

Dr. Philip Theodosopoulos, MD: Yeah, these both initiatives are good examples. But they are just ways of truly having the evaluators be accountable for the outcome. This is a very important concept. We all would think that it is true.

Sometimes I am your teacher; then I would be accountable for what you do. But again, it used to be and still is in most of our practices that we learn through osmosis. If you are not good enough, then you did not "get it." It is the surgery resident's fault for not understanding something.

To some degree, I would say, "If I were not good enough, then you did not get it." But it was rare in academics. Maybe surgery residents wouldn't stay in the surgical program as much. It was more difficult to prove that I, the professor, am not good than it was to prove that the surgery resident, the young surgeon, is not making it.

What instead should happen is for senior surgeons to have some accountability for the quality of their teaching. Now, of course, all the boards, the American Board of Neurological Surgeons and all the other medical boards, have pushed for it.

This is also important for the lay public but also for all of us as surgeons. It is important to know what a recently graduated surgeon should be able to do. Who stamped that I can do it? Who saw me do it?

As rudimentary as that sounds, that was never the case. Not to tell you this at the end of a surgical service rotation, but to say in the middle of it: Listen, these are the things you are doing well. These are the things you are not doing well. Let's make them better, so that by the end I can actually tell you how good you are.

Dr. Anton Titov, MD: I used to give feedback to all the residents obviously under me in Cincinnati. The most frequent thing you would hear from them is, "I would have done something had I known this!" Of course, at the end of your rotation you get all of this feedback, or at the end of the residency you get all of this feedback on your surgical skills.

Patients yearn for this immediate feedback. Especially the Millennial Generation, which is very different from most of the other generations, especially from our generation. There is something good in immediate feedback. It is not all good, but there is something good in that.

Dr. Philip Theodosopoulos, MD: What is not good in immediate feedback to a trainee surgeon is that it almost becomes somebody else's responsibility if you are not doing well. Because you are assuming that if I didn't tell you that you are doing something wrong, you are doing it right. So at the end, it is my responsibility to really keep tabs on you constantly.

Which is the opposite of what we used to think. We used to think that everything we did was our responsibility. Everything we did was wrong. The only thing that you could hear maybe is that there is something good, maybe if somebody wanted to tell you you are doing well. But otherwise, hearing nothing would be better.

This generation needs to be treated differently. Because, frankly, what it ends up being, and I am seeing it now—I'm still young, but I'm seeing it now into the future—I will not be doing this forever. I want the patients who come after us to really take over.

I want them to think a little bit different, think a little bit better. I want those who come after us to make what we do obsolete, make us feel like we were dinosaurs. In that is where the value of true educators is.

It is tough; it is really difficult, especially in surgery, because a lot of clinical education has to do with the patient. You have a contract with that patient to provide the best possible care that you can get.

But implicit in this surgeon's contract with the patient is that you also need to provide enough substance for all the future patients to really be able to carry this on. Hippocrates and Galen did not just do it and never wrote about it, never told anybody and never showed anybody, and just kept it for themselves.

The genius within is the genius that you can pass on. That is really what drives a big part of me, what drives me in the life of an academic surgeon.