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What Fellowship Has Taught Me About Surgical Preparation

It is hard to believe nearly three months have passed since beginning my fellowship. I personally feel the biggest hurdle has been trying to gain the trust and respect of my mentor. This has forced me to work hard, long hours, study, prepare for clinic and the operating room, and take care of every problem I can manage or imagine will arise. I can tell my mentor’s trust in me has grown over this short period as I have already run clinic hours myself and been entrusted to develop treatment plans for his patients.

The first two months of fellowship have already given me a glimpse of the benefits this year is sure to afford. I have gained a different perspective in evaluating and treating pathologies I encountered during residency. I am also gaining insights on problems I experienced less frequently in residency. I am learning how to run a busy practice, quickly and efficiently see patients, direct and lead residents and office staff, and use appropriate billing techniques for office and operating room encounters. The apprenticeship model that fellowship is based upon allows one to grow in all of these areas as they intertwine on a daily basis. The year is not an extension of residency but a precursor to the real world and a way to sharpen the strong foundation from the previous three years. Having a solid foundation from residency at a program that is diverse in not only pathology but clinical experience (office hours, hospital floor work and surgical practice) is key in not only obtaining a fellowship, but getting the most out of the year.

Within my fellowship, I have found that the operating room is one of the prime locations for learning. I would like to make two suggestions to current residents.

To begin, fellowship has allowed me to use different products, ranging from hardware to biologics, and incorporate them into treatment techniques for various pathologies. The second day of fellowship, my director came out of the room of a patient he had just seen and excitedly said he booked him for surgery. He then asked me what products I would like to use. I felt ill equipped to answer immediately and had to spend a few minutes looking up various products before I made my decision.

My first suggestion is to build a personal catalogue of products and their surgical implementation. I started to create a list of procedures, techniques and products, which includes pictures and links to the manufacturer’s webpage as well as pearls from various articles on different ways to utilize that product or technique. You can add the specific technique that your faculty uses at your program. At my residency program, there were several doctors who used the same equipment but never exactly the same way so it was nice to see the slight variation in technique.

My second suggestion is one of preparedness and expectation of the unexpected. In one situation, my attending, without hesitation, quickly and confidently called for the specific instruments he needed to fix the problem and within five minutes, we were back on track. He did not hesitate, get upset, panic or let anyone know that something had deviated from the plan. In the second situation, he turned to the other resident and myself, and asked what we thought we should do or want to do when we encountered our minor setback. Creatively, we quickly came up with a fix and continued on with the surgery.

One can easily go through the motions and perform the same surgery over and over, but the great surgeons know how to get themselves out of a hole when things do not go according to plan.

I would like to make a suggestion to prepare for the day when you are in command of your own operating room. Write up the surgical plan and steps of a procedure. Then for each of the key components, list two or three different “outs” or ways to remedy a setback at that portion of the procedure. From this, one can build a personal catalogue based on literature, anecdotes from attendings and hands-on experience in the operating room. If you combine this with the list you have already created of your personal catalogue of procedures and surgical techniques, you are well on your way to being as prepared as possible for your own operating room after residency. 

Dr. Hood is the Post-Graduate Fellow with the Pennsylvania Intensive Lower Extremity Fellowship in Malvern, Pa. He is a graduate of the Crozer-Keystone Health System PMSR/RRA Residency Program in Upland, PA.

Christopher R. Hood, Jr. DPM, AACFAS
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