See One, Do One, Teach One
The mantra See One, Do One, Teach One is well-known to all physicians – especially surgeons – and serves as the philosophical foundation of our graduate medical education (GME). It represents all that is traditional and good about the process, but also what is inherently challenging. The Accreditation Council for Graduate Medical Education (ACGME) has partnered with the Residency Review Committees (RRCs) and specialty boards (like the ABNS) to update and improve many components of physician education, but this age-old philosophy still exerts considerable sway. On the positive side, this approach:
- Encourages teaching across the spectrum of providers;
- Supports appropriate supervision (at least in part); and
- Promotes progressive independence essential for safe practice.
Unfortunately, there is real potential for problems. These include:
- Observation without supportive teaching or modification may not allow the full appreciation of what needs to be done;
- Erroneous assumption that the initial teaching is correct (i.e. the student may do exactly what they saw, but it may, in fact, not be the correct or best way);
- Dependence on all involved in the system desiring and being capable of skillful teaching and training; and
- Failure to understand the dynamic and nuanced nature of the practice of medicine.
Most of us still have clear recollection of a “eureka” moment during a technical or clinical endeavor. This involved discovering a relatively simple nuance with great impact after doing something many times in less optimal or efficient ways for a long time. I admit to having many! One such moment was establishing the optimal placement of the Mayfield pins for posterior cervical surgery. Clearly, I had used many variations before finding that sweet spot that I now use every time. I still wonder about how no one demonstrated this to me during my entire training or perhaps they did, but I was not ready to absorb that information and thus it was lost for a long time. Other such inspirations have been as simple as a shortcut on the computer/electron medical record (EMR) that perhaps saves just a few seconds each time, but is used so often that it has tremendous impact on workflow.
When this happens, one may think, “I wish someone had showed/told me this sooner!” Confounding this is the pervading environment across medicine that strongly discourages admitting you do not know something or even questioning if there is a better way. Unfortunately, I also know personally of neurosurgeons who have suffered tremendously from:
- Failure to have up-to-date Wills and Testaments.
- Appropriate response to a malpractice subpoena.
- Insufficient disability insurance.
- Noncompliance with Federal, State or Hospital regulations.
As another poignant example, after 25 years practicing in the New York metropolitan region (faculty at Columbia College of Physicians and Surgeons), I recently migrated to the Cleveland Clinic. This gives me yet another perspective on the importance of giving advice and sharing experiences – as well as the effects of not. I have been struck on many occasions by the number of best practices at each institution that are not known at another. Despite the explosion of big data, the capacity for lightening-fast communication and the clarion cries for quality and value, there remains a distinct failure to integrate best practices and gain the maximal benefit from the many eureka discoveries – small and large – in the practice of medicine.
Be sure to check back weekly for more articles.
Perhaps, most telling about choosing the advice concept for this issue of AANS Neurosurgeon was the enthusiastic and vociferous response on potential topics to cover. Even our expanded, digital format struggles to highlight the wide spectrum of issues suggested, which include:
- Practice management
- Technical skills
- Career advancement
The willingness of so many to contribute expertise and personal advice to benefit others is quite rewarding. The result is that the AANS Neurosurgeon will launch a new format: sequential publication of material. Unlike our traditional print version or its online replacement, starting with Volume 27, Number 3, feature articles will be released over several weeks. Stay tuned – technology and changing times will drive further changes to this long-standing publication over the next few months to best serve the needs of today’s neurosurgeon.
Back to School
Summer draws to a close. The classroom will soon replace the days of sun, sand and fun. Honoring that tradition, we present an issue full of sage advice across many subjects that should be of interest to students of all ages and experience.
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