Mentor – Trainee relationship in surgery. What it means for millennial surgical residents? 7
Surgical mentoring is a key task for all leading neurosurgeons. “The genius within is the genius that you can pass on”. Leading neurological surgeon advises. ”You are not a genius until you can transfer your genius to new generation.” To become leading surgeon, you have to spend 10,000 hours alone with your study subject. For neurosurgeons, the subject of the study is a brain and skull. Spend 10,000 hours alone within your surgical subject. Advice to young neurosurgeons. Surgical mentoring. Dr. Anton Titov, MD. Video interview with leading neurological surgeon. Dr. Philip Theodosopoulos, MD. Modern education in surgery requires 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 surgeon. Millennial generation surgeons seek immediate feedback. It is important for public to know who stamped that surgeon can do this or that surgical operation well. Dr. Anton Titov, MD. How to become the best surgeon? Dr. Philip Theodosopoulos, MD. Study anatomy of your chosen surgical specialty. Devote 10,000 hours one-to-one with your study subject. For neurosurgeon study subject is 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. Advice from leading skull base neurological surgeon. Dr. Anton Titov, MD. Medical Second Opinion from leading surgeon can confirm that diagnosis is correct and complete. Medical Second Opinion also helps to choose the best treatment for any surgical problem (tumor, heart surgery, trauma). Dr. Philip Theodosopoulos, MD. Seek medical second opinion from independent expert and be confident that your treatment is the best. Advice to young neurosurgeons. Surgical mentoring. Dr. Anton Titov, MD. And patients quote two specific things that you have done in the neurosurgery residency program. Dr. Anton Titov, MD. 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 (Neurosurgeon, Director, Skull Base Tumor Program, UCSF). Yeah, you know 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. Dr. Philip Theodosopoulos, MD. 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 we learn through osmosis. if you are not good enough. Then you did not “get it”. It is surgery resident’s fault for not understanding something. to some degree I would say: “Well, 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 am the Professor not good than it was to prove that surgery resident, the young surgeon are not making it. Dr. Philip Theodosopoulos, MD. What instead should happen is for senior surgeons to have some accountability for 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. Dr. Philip Theodosopoulos, MD. As rudimentary as that sounds that was never the case. not to tell you this at the end of (surgical service) rotation. But to say in the middle of it: Listen – 1,2 3, – these are the things you are doing well. – 1, 2, 3 – 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. You know, 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 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. Dr. Anton Titov, MD. 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 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. Dr. Philip Theodosopoulos, MD. You have a contract with that patient to provide the best possible care that you can get. Dr. Philip Theodosopoulos, MD. But implicit in this [surgeon’s contract with 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 academic surgeon. Dr. Anton Titov, MD.
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