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I must admit.I’m a bit compulsive and freaked whenever a close person get sick or will undergo a surgical procedure.

In our family, I’m the only medically “knowledgeable” person. Being a  the medical guy in a family is a whooping responsibility.

Yes it is.

The three or four surgeries my mom and sis went through plus the numerous getting sick moments other family members experiences extract a heavy toll on my stress reserves. Of course my medical training helps, especially in the part where you plaster an emotionless face to keep a cool composure.  Yes,we play the hands of god to heal. For that, we need a calm, fluid, sewing, hands.

But this time, not even my M.D. training could ever down play such stress on my composure. Ironically, being an MD fine tunes your senses and pushes you towards compulsion to details whenever someone close to you get sick.

Why? Frankly, I don’t know.

As one good surgeon mentor told me before..

“you can never be a real surgeon unless you went through the knife yourself”..

Then suddenly it dawned on me. The closest thing for me to go under a knife until now,  is for any of my my closest people to go under the knife.  And that for the nth time, my mom would undergo one soon.

Her past surgeries were all emergencies. The decision making is emergent. The preparation is shorter and the options, close to nil.She’s left to a single emergent choice and then pray she’d wake up outside of the slim “margin for error”.

So you’d think  cataract surgery is minor. If you have seen how the almost blind, seemingly helpless elderly gropes in the dark while being carried to the OR, you wouldn’t think so. Better preparation, more choices and therefore less risks? Heavens no! With such wider margin for error comes the greater responsibility and risk of not missing any slightest detail. You bought only time to prepare, and therefore reduce the risks. But after that, it is still a surgery. If you miss something on the preop, given the longer preparation you have chances are the results would be a catastrophic guilt for the family. In a closely knit family culture of th e Filipinos, the guilt is pretty much an issue. And If your mom is on the OR table, everything is definitely “major”…

So never mind if my mom is diabetic with beginning retinopathy. Never mind if she has had 3 major surgeries before and countless other hospital admissions due to some sickness. Never mind she survived all of those. When your face by this same predicament and even on better circumstances, no surgery is still minor. Especially, if it’s your mom is on the receiving end of a surgeon’s knife.

So I go on with my usual compulsion to detail,  to my often obnoxiously redundant reminders of doing this and that pre-op. To most this might be an overkill. But If I were the patient, I’d love my surgeon to do so the same for me. Take the extra steps of care. That extra effort gives me a little security about my surgeons care for me.

This is one of the good  insights I learned from my mom’s procedures. You feel for your patients, you put yourself in their situation and imagine the best option your surgeon can offer. I always apply them to my patients. I teach this to my residents. Stressful? Yes it is. But who said the life of a surgeon is easy anyway?

So thank you mom. For undergoing the knife for me. You help mold a better surgeon.

(An update: I know my mom’s surgeon don’t read this write up, but I’m all praises for the guy. He didn’t just made an extra effort for my mom. Everything he did was a piece of his class. Masterful. Thank you..)

In just about a year and half of teaching orthopedic residents, I became interested in finding out which of the more familiar teaching styles works best for our crop of trainees. Honestly, I’m still continually experimenting.

The unique set up with which medical-surgical training programs thrive is continually changing. With the influx of medical information everyday, a program has to adapt to the call of time and for greater efficiency in preparing this ‘padawans into full pledged surgeons.It is not simple as it seems however since in this unique set up and unlike the usual academic, lab rat experimentation, a mistake might cost someone else life.

The “Master-Apprentice” method ( probably the more popular and is what I’m familiar with) involves  the “master” (attendings) showing the “apprentice” (residents) his way of doing things (skill) for a certain given situation or problem. Such teacher-student relationship is basically anchored on the assumption that the master is more experienced and adept than apprentice. This is usually an “I teach, you follow” approach to learning. One advantage of this approach is the specific skill imparted by the master to his apprentice for any given orthopedic problem. The obvious disadvantage is its limited applicability and the temptation to spoon feed a resident.

The rapid influx of modern technology and a deluge scientific evidence paved the way for a more radical, and holistic approach to learning in orthopedics. To the end of my training I was deliberately hammered by mentors to think rather than learn a specific skill, to criticize the validity of any information presented and above all, develop a logical framework for decision making process in any given orthopedic problem. Skills and techniques came in later as my mentors believe that modern technology will techniques change every 5 or so years. I am not an expert on education or teaching styles, but the latter method seems to work best for me. To my understanding, this sort of teaching style fall into the Socratic method of teaching. I’m really not interested into that. What I’m interested now is, if it’ll work too for my residents?

In every opportunity I have with our residents, be it conferences and pre ops, I focus on continually challenging their minds,  make them think harder, analyze a given situation,  criticize an evidence, present facts properly and then develop a sound decision making process. Obviously, I’m not a fan of residents trying to impress attendings with techniques and implants when he can barely utter a word on the biomechanics involved in those implants. Often, the common excuse for residents (this is awful) is the absence of patients  logistics and financial support common among government hospitals. I actually do not contest that. What we want for residents however, is to incorporate these specifics into his decision making process so he can plan ahead for his patients surgery Lastly, I wanted my residents to empathize with their patients. One common question I throw in during pre-ops is this

If you we’re the patient, what would you want your surgeon do to you?

 Usually this type of questioning gives the residents an idea as to the best option for the patient!

All of these teaching style have one thing in come though. To pass on knowledge to the new generation of orthopedic surgeons . In short, were training them to be surgeons not residents.

Will these teaching style work for our current residents? Personally, I don’t know.Not yet, but perhaps in the future.