← The AOFAS Orthopod-Cast
The AOFAS Orthopod-Cast
Incorporating Teaching Strategies Into Your Practice
00:42:35
Listen in as co-hosts Drs. Lauren Geaney and Matt Conti chat with Drs. Jim Holmes, and Becky Cerrato about education of residents and fellows and provide pearls for those teaching trainees. Brought to you by the AOFAS Young Physicians Committee....
Loading summary
Transcript62 lines
- [00:01]
A
Welcome to AOFAS Ortho Podcast, where leaders in foot and ankle orthopedic surgery discuss the issues that affect you and your practice. Please note that the views expressed on this podcast do not necessarily represent the views of the AOFAS or its members. Hello, everyone, and welcome to the AOFAS Ortho Podcast. This is Lauren Gainey coming from the University of Connecticut. And I'm really excited that today we're going to be talking about teaching strategies. And I think this is something that we all struggle with, those of us that teach residents and medical students and fellows. And so I'm really excited today to be joined by a really great panel. I'm here with Dr. Conti from HSS who will be helping me host host this. We also have Dr. Serato from Mercy Medical center, who is the current fellowship director, and Dr. Jim Holmes from the University of Michigan, who also works with residents and fellows. So welcome to everyone and thank you for coming. I'm going to start out first and just get a sense from everybody about why did you get into education and what currently is your role? So I'll start with you, Becky.
- [01:20]
B
So I have the unique position of saying I'm in the same spot that I've been in since I left my fellowship, which we know is not the common practice. And what's interesting, when I was leaving my residency, I knew I wanted to have some involvement in education and dealing with potentially residents or collaboration. But it wasn't this big focus of mine when I necessarily left residency. But absolutely my goals shifted when I did fellowship and very quickly, just because it was just something I enjoyed so much and I could just see myself in that role. So it just organically happened as I was a fellow, that it was something I was interested in doing and I was just fortunate enough for my fellowship program to need somebody at that time and want to have me, and the rest is history. I've been there since then.
- [02:20]
A
And how about you, Jim? What's your interest and how did you get involved?
- [02:25]
C
I was actually in private practice for the first 19 years of my practice and we adjacent to the university and we had residents that would rotate with us on a somewhat itinerant basis. We had limited exposure. And really after that, excuse me, that period of time, I don't want to sound too, too dismissive about it, but the surgery became like factory work, the same thing, clinic two or three days a week and then go to the or two or three days a week. And it's just not exactly like an assembly line, but a Little bit of that. And so I found myself getting a little bit stale and nobody was challenging me on anything. And it a few other things were happening administratively and I'd always had my foot in the door at the university. I would still go to conferences and so on and so forth. And so I decided in about 2009 it was time to do something or not do anything. And so at that point I came over to the university full time and then became the associate program director about two years after that. So things, happily and luckily, I guess I should say, fell into place for me. But it really, for me it was the need for some more stimulation, some interaction. And after a few years, you'd like to think that you've got a few things to share. Time will tell.
- [03:40]
A
So, Becky, as a brand new fellowship director that I am, one of the things that I've struggled with is assessing these new fellows when they come in, because I think a little different than residents. Everyone's had a little bit of a different training, they have different abilities and they're all starting out at a different place. So how do you assess a fellow when they come in to see where they're starting from and how best to help them?
- [04:05]
B
That's great question in the sense that I think it took me years to get reasonably decent at assessing that. So, and you're right, every single fellow is going to come in and their qualifications can be relatively similar, but their background's going to be so different on what they can do, how much they've operated, how much foot and ankle they've been exposed to. And over the past several years, I've learned to give. I usually try to set up the beginning of my rotations with some of them, with some, if you want to call softball cases, if we can schedule them that way, ones that are, I think, amazing teaching opportunities, but also something that I feel comfortable letting them get their hands on because you really don't know what their skills are until they actually put the knife in their hand. You know that, right? Or they try passing a guide wire and readjusting it and then you really learn something. The other thing I've learned a long time ago is you need to add more time to those cases. So in the beginning of, and we just prepare our hospital for that, they know that when I, when we have our new fellows coming in, what would be maybe an hour and a half long case is going to be two or two and a half hours. And the, the reason is because I don't want to just let them sit there and watch for three, four months. They need to see me do a couple things, but really get engaged with it. And if that means that I have to just pull back and help them through it, I help them through it. And there's going to be some that impress you, and you're like, oh, my gosh, I can. We're going to go faster with this fellow. And then there's others that you're just like, that's okay. We're going to, we're going to take our time. And every single case, they're going to learn something from it.
- [05:53]
A
And one of my least favorite questions from the ACGME is, how do you assess competence? And how do you know how to give graduated autonomy? That's a favorite term that they use. Maybe Matt or Jim, I know you work with residents. How do you allow that? And my instinct is always say, you know it when you see it. But what does that mean to you?
- [06:16]
C
I don't. Certainly don't have any magic. I think for me, it starts out if we're talking about graduate autonomy in the operating room. For me, it starts out before you get to the operating room. I ask, and we ask on our service, we ask them to submit an operative plan before we talk about it. We ask them submit in writing the operative plan and case review. So if, if they don't send that plan and don't have good reason, or if the plan is cursory, or if the plan is way off base, then I worry about my ability to provide, to let them find their way in the operating room. So that's the. For me, that's the first hurdle. If they do that, then that's great. We talk about the case. I tend to get the first case pretty early in the morning, almost an hour before we start. And they know that. And so we have an opportunity to review films and go through that. And if I'm comfortable with what their plan is and we go through all the things that you all go through, what are you worried about? What should I be worried about? What could happen? What happens if you cut that? What do we do? So if they get past the second hurdle, if they know the anatomy, they understand where they're going to be, they've told me what we're going to do, then I'm perfectly comfortable letting them. I tend to not be someone over at the computer console. I tend to. I'll, I'll scrub and with them, and we'll go through it. And they can go as far as. I think it depends on the level of arrest, obviously, but we let them go as far as they can until, until either they ask for help, which usually doesn't happen, or, and they don't do anything wrong, but they stall. You get to a certain point and they don't know what the next step is. And we have younger residents oftentimes on our service and frankly, I don't necessarily expect them to know at every step. And so we help them along. I don't have any magic and everybody's different. Right. You need to find out where they're at and where, what they're comfortable with and what their desire is. But if they're prepared and enthusiastic and demonstrate a knowledge of the anatomy, it's going to be a, it's going to be a good day in the operating room for me.
- [08:16]
D
So I, I have a question along those lines. One of the things I, I teach, so I don't, I'm not on any specific rotation. So I teach a combination of residents and fellows and, and because no one's assigned to me because I have nothing to teach yet but hope maybe one day. And so like the problem. So how do you guys approach like the resident who maybe isn't that interested in foot and ankle? That's the thing. Like I like sounds like they're like, there's a resident comes in, they're like, I'm going to go into hip and knee. And so they don't mind being there for the case, but they're not super interested in learning versus like the fellow who is super motivated to learn. And I struggle with that because I really enjoy like the fellows that, you know, come in and they're super motivated. And then I'm like, sometimes it feels like I'm pulling teeth with the residents. How do you change your teaching strategy based on if it's a resident or fellow?
- [09:09]
B
So if I grab that, we have, so we have four fellows, but we also have a PGY3 that comes and rotates constantly through with us. In fact, I have the resident with me right now and he's going into spine, but he's actually a fabulous resident, very interested in just learning everything. It's not just going through the process of it, but I think some of the things is you really need to get them involved in the thought process. Just like Jim had mentioned in whether it's case preparation. We have case conferences every Thursday. And if the residents with me, I don't care if they're interested in foot and ankle, I'll ask them to find a really cool case that we either did or we saw. Get them involved with it. I'll help them put together the presentation. And I would say the vast majority of the residents, when you. They're not just going through the motions and rounding on people and being there to sign orders and stuff like that. The vast majority of residents that I've worked with, even though they're not going into foot and ankle, they've thoroughly enjoyed participating in our education and them themselves learning and stuff like that. So I think you have to put a little effort into getting that non foot and ankle resident involved in it. And they're going to do it. I would have done it myself as a resident had I been engaged really well with anybody. Spine, hand peds, any of those specialties, it would have been something that I would have been more interested in or would have been really enthusiastic to be involved with it. And I was when I had those attendings engage me and incorporate me into those things.
- [10:53]
A
And I think it comes down to, in the end, they want to operate. They're not going to be really excited if they're sitting and watching you operate. If they know that they, if they do the work, they're going to actually get their hands on the knife, then I think that motivates them. But I also. It's a little different, I think, Matt, if you have somebody randomly come in here or there, having somebody on my service at the beginning, I sit them down, I say, what do you want to learn from this? Some of them want to learn how to scope because they're doing sports and they want to talk about brums and ocds and Achilles ruptures. And some of them just want to do fractures because they're going to be in a practice where they're doing trauma. So I think the. The great thing about what we do is we dip our hands in all of it, right? We do sports, we do reconstruction, we do all those things. So no other than spine, perhaps, no matter what, there's something for them to learn. And at min, sometimes they want to talk about consulting in the business, and sometimes they wanted. The thing I think that we can teach them that no one else can is tissue handling, because that's such an important thing. And even my chairman, who's a spine, he said, I. What I learned about soft tissue handling, I learned in my foot and ankle rotation. So I think you just have to take what we do and make it important to them and let them get their hands dirty if they put the work in.
- [12:08]
C
Yeah, I couldn't agree more, Lauren. I was Just going to jump in. I think another way to say that is that we can also teach them principles, principles of tissue handling, principles of. It drives me crazy. Somebody teaches them to make a skin incision, then take a hemostat and just tear the heck out of the soft tissues to get down there. Because apparently they're scared of cutting a nerve and they're scared of cutting a nerve because they don't know where the nerve is at, apparently. So we can teach them a lot of principles and soft tissue handling and anatomy. And the other thing to your point is if you're going to do Joanne, with maybe the exception of spine or hand, but probably their first job, they're going to be taking trauma call. And it turns out it's a pretty good idea to know what foot and ankle anatomy is like and how to approach things and how to put plates and screws on there. Sometimes they don't know what they need to know and for sure that's what's going to happen. Try to make that clear. But I think for sure the principles of soft tissue handling are really important. The more important probably in the foot than almost anywhere else, maybe the hand. The only other thing I would add to that is we're focusing on the technical aspects of our specialty, which we should be. But the other thing I think they can take away, and this is not a function of specialty, but a function of the fact that a lot of things we take care of are non operative problems. So we see clinic patients and spending some time in the clinic to sort through how to manage difficult patients or difficult problems, evaluate that I think is really important and they get that. Probably other places, but certainly less so, probably in trauma and some other places where they see less, less patients in clinic. But I think we can offer that up too because so much of what we do is oftentimes it's as important of not indicating a procedure or discouraging them rather than doing the operation. And I hope they take something away from that.
- [13:57]
A
So one of the things that has come up a lot that I struggle with my role in the residency, maybe a little less so in fellowship. But residents, they really want feedback, but they really want positive feedback and negative feedback. It's hard for anyone to take. It's hard to give. So I'm curious how you have incorporated that, how and how frequently how you give it and how you give it in a meaningful way.
- [14:27]
B
That is, I. I have to say that might be one of the biggest challenges for me personally as an educator for fellows and residents, because I'm just not. That's not my personality. I don't want to be confrontational. I. Everything wants to be positive. It's just easier to get along, have a great time in the OR and clinic and stuff like that. But the reality is, like you said, that's not fair to them and they don't want that either. They also don't want negative if they deserve it or. But sometimes when you give only positive, some of them don't feel like they learn very much from it either. They, they want honesty. So what I've learned from my personality, the other thing too is you have to learn as an educator. You got to figure out how you do best because not everybody educates the same way. I, being non confrontational do a much better job on weekly intervals giving feedback to my fellows now versus in the past I used to sometimes wait until they left my rotation after five to six weeks and or as a fellowship director I'd sit down with them after six months and have all the evaluations from everybody. And I hated that. I hated that. And so now I just feel really good about it. Just it organically works with my personality, with them because I just want to build people up and a lot of it is that way. But we can sit here and talk about that week and I think that's helps them a little bit better, at least in my mind how I can communicate with them. But also when you sit here and talk to somebody about how they performed on certain cases five weeks before or whatever, maybe that doesn't help him as much as let's talk about our cases for next week and then let's talk about this past week. Let's talk about what you saw, what you did, what you might have missed and different things like that. And, and then I will sit down with my fellows at the end of the five weeks and we do a review. But it is so much easier now that I have been doing it almost on a weekly basis.
- [16:40]
A
And Becky, do you give them just when they're on your service weekly feedback or you're giving them feedback weekly based on whatever service they're on?
- [16:48]
B
Just mine. Just mine. Yeah. I'm not taking the other fellows with that. Let them take that over.
- [16:58]
C
I think it's easiest to give feedback positive or negative for me at least in real time. So in the operating room, don't do this, don't do. That's great, that's good. Keep. No, not that sort of thing is easier and they get. It's not, I hope not quite that Annoying, but I suppose in their lens it might be sometimes, but. But that's. And that's positive and negative. And I try to do both sides of it. I think the worst thing and the same thing in clinic, like, they know if that they missed the diagnosis or that's not the exam, that sort of thing. That's immediate feedback, and I think that's constructive and sometimes negative and sometimes positive, but it's immediate. I think on the other side of the spectrum is I think what in this, we do probably the. It's the worst thing to do, I think, and that's not to provide any feedback for the month and then fill out at the end of the day, at the end of the rotation, fill something out. Particularly if it's negative, it's positive, that's fine. But to not get that constructive criticism during a rotation and then to see it show up and say, didn't meet the mark, I was concerned showed up, whatever that it is, I think we've done them and ourselves a disservice. So I think given that none of us like to be confrontational, I, I agree, Becky, but I think if it's, if the information is given in real time, it's more likely to be construed as constructive and less critical. I think, again, maybe I'm the wrong person to ask about that, to talk to the people at the other end of the, the knife, but I hope so, at least.
- [18:26]
A
I guess, to that same point. At what point do you get concerned? I think the struggling resident or learner is a really hard thing. And I think, again, having being new to the fellowship world, when I had resident for five years, you had a little bit of time. And with one year not knowing them at all coming in, at what point do we get concerned? Are there red flags? Are there things that you're looking for to say, gosh, this is somebody that I need to be, that needs more help than what we're currently giving them?
- [19:00]
B
I would say fortunately for us. Honestly, I can't think back in a while. You'll have amazingly strong and maybe fellows that aren't as strong, but I haven't had ones that we have had. Okay, maybe we need to have an intervention per se, but there's been conversations. I think, number one, just like Jim had alluded, you need to communicate with that fellow very quickly. You can't let this go on for a couple months. If yourself and your other colleagues who are training the fellow, or even if it's just yourself have significant concerns, whether it's in Their judgment or their performance and stuff like that. This needs to be addressed real time, right away. And then I think you have to create strategies on. Okay, how are we going to. Even if it's just we're going to look back at you and I are going to sit down every single week and we're going to go over the cases that you did and or whoever's the attending with that person. I personally find sometimes some of the things that can be most concerning is not necessarily the skills in the or, but the skills in assessing in clinic the diagnosis, treatment plan and documentation. Sometimes the documentation be really poor. And that is to me, a big red flag, but something that could be, all right, let's sit down and we're going to. You have to create an action plan for that trainee, whether it's a resident or a fellow, so they know what the concerns are and they know what the action points are that they need to work on and that are going to be evaluated by them. If you wait, then I just think that's going to be an unsuccessful outcome for both your training program and the trainee. That's not fair to them either.
- [21:04]
C
Yeah, I think it gets to. For fellows. We don't have fellowship fellows, but your senior residents or fellows. I think you have to have the long view. Like pretty soon they're going to be unleashed on the public and you're the last, you're the last, you're the last stop in that station. Not really, but the, the last formal stop maybe is a better way to say it. So I think not to be too formal about it, but I think it's our responsibility to really catch that. And that's what you're talking about. Lauren, I, I get. And I think there's a spectrum. For me, the list from least concerning to most concerning is making the same mistake two or three times. You made the mistake, you had feedback. A week later you made the same mistake, you had that feedback and maybe do it three times. That to me is a red flag. Like you had that feedback. Something like whatever that is. Is it a processing problem? Is it a problem not caring? The second is making mistake, having it pointed out and minimizing it. Oh, that's not a big deal. We can just put a stitch in the tendon. It's not a big. They're going to be fine. Maybe they're going to be fine, maybe they're not. I'll be taking care of the patient, thank you very much. It's not for you to say. That's not going to Be fine. And then the third is a tie between arguing about whether it's fine or not. This is the way they did it on the whatever service, and it's fine. So you're not on that service now. And I happen to believe that. And I've got some reason to believe that this is the right way to do it and you shouldn't do it that way or really not being entirely truthful about justifying their. What they did or didn't do. So that's a little too far down the rabbit hole. But I think it starts with make an honest mistake two or three times after you have the appropriate feedback. And if it gets to the point where they're just nonchalant about potential complication, that to me is a really big red flag. Fortunately, it doesn't happen. But. But it's my. The incidence of that in my career is not zero, unfortunately.
- [22:55]
A
It speaks to the same point. One of the things that, you know, I struggle the most is professionalism issues. I think that technical issues we can remediate. I think that professionalism, honestly, has been probably one of the hardest things that we've had to deal with on our residents. Have you guys had to deal with that? Do you have any tips for how to do it? Because there's not a lot of data out there, and it's something that we really, you know, fortunately doesn't happen frequently, to your point, Jim, but when it does, it's a real challenge.
- [23:26]
C
So I'll just start on this. I feel really strongly about this. I've proven time and time again that despite the fact I thought I was a pretty reasonable judge of character, I've been proven wrong more times than I'm willing to admit. And it is unequivocally the most important characteristic you can train. Bill Smith, who was chair here just before I started residency, said, you can train a lab monkey to operate, but you can't train a lab monkey to indicate procedures, manage complications, and. And he said it euphemistically. But the problems that wind someone up in the principal's Office and the PD's office are almost always behavioral. And I say when you're interviewing fellows or residents, the most important thing is that is those professional issues. It's also equally the hardest thing to assess. And I'm almost. I've gone through lots of iterations on interviews and what's important and so on and so forth. I think if we're in interview season for fellows and for residents, the most important thing we can do is to find, identify Those very few people who are going to be a bad fit for whatever reason, which sounds really easy, but that for me has evolved into the sole focus. Anything else we can work through, right? Virtually anything else. But someone whose personality is a conflict, who's going to have some problems, and it's not very evident. Right. They, they choose their letter writers. They did fine in class. Right. Unless you know somebody who knows somebody, which does happen, fortunately in our business, it's pretty hard to identify, but others have different opinions on it.
- [25:04]
A
Maybe. What, what I find frustrating is that these, the people that do have trouble with this, they get through high school, they get through college. Nobody's ever assessing professionalism until they get here. And somehow everyone cares about their MCATs, everyone cares about this and that, but nobody's evaluating the professionalism. And at this point, it's a very hard thing to change once they're in their 30s to say, hey, those behaviors you've had for 30 years that nobody's told you is not very nice, stop being a mean person. And I find that really challenging that they've come this far and again, they've been very successful thus far. And then trying to explain to them that, that you're at a different, much higher standard now is a hard thing to teach somebody.
- [25:54]
B
Just to piggyback on both of what you guys are saying, I agree. And having done this now for quite a few years, sometimes I look back at the applications of fellows like, what did I read different? What was different? And I would have to say that professionalism and character of a person were just not able to glean that from their application. You're just not going to get it. Even trying to look for it. I'm not going to get it, fortunately, I think it happens so infrequently, but I agree with you. And I think if somebody comes to me as training, as a fellow, particularly, and they've gone through medical school and residency, and I don't even think any of those things, like, how am I in one year going to change their character? Probably not. They are who they are. The best thing I can do is they can follow. They're going to watch me when they're on my rotation and they're going to watch my partners when they're on their rotations. And our character is pretty outstanding in that sense and how we put our patients first, or that that's the only thing I can say is, okay, maybe in this year they'll get inspired. But you tell me if you pick up something on an application that I can find that. You're not going to find a letter that sits there and says, all right, this guy's a bad apple. It just doesn't happen that way.
- [27:29]
C
So I actually have this all figured out and I'm going to share it with you guys now.
- [27:32]
B
Okay, good.
- [27:33]
C
And this is, this is the Holmes triad for evaluating learners. All right. You might want to write this down. So I joke about it, but I think it's true. And when you, when I finish this, you're going to think of names and you're going to go through this. So there's three scales that you can assess people on. Three broad scales. The first one is their intelligence, their ability and that's got a lot of things right. That's their, a little bit of their emotional intelligence. But their test taking ability, their knowledge of the information includes their technical proficiency and all that sort of thing. And so you get the ends of the spectrum are two thumbs, can't operate their way out of a paper bag, don't really know much of literature, barely scored. Well, the other side of the spectrum is wicked smart crazy board scores and are functioning at the level of an HO3 as a, as an M4. Right. So that's the first one. So intelligence. The second one is work ethic. On one side of the spectrum, first person in the morning, last person out, always taking the harder job, always, always in the middle of the fray and nobody's going to outwork them. And the other side of the spectrum is showing up a little bit late. Maybe someone else does their work for them and that sort of thing. And the third scale to your, or the third limb to your point Lauren is really professionalism or affability. Nice gal, nice girl, really love to be, love to have him come over for dinner, really like to spend some time with even out of work, that sort of thing versus man, that person is crazy. It's like I can't stand being on service with them. They just, they're just annoying like crazy. The magic is that the rock stars that are, that come to go through programs that are all three. The highest end of all three of those intelligence, professionalism and affability and hard work. They come around about once every two years. Most residents are two out of three and it doesn't make any difference what those two are. And this is to your point. You can be wicked smart and be a hard worker and people are going to overlook the professionalism stuff because you show up, you do your part and that sort of thing. So pick any two and that's most residents. The one out of threes are a problem. Right. And I've seen. I've only seen one over three that I recall. One out of three. And the one on threes fortunately don't come around very much either. But most residents. And it doesn't make any. You'll think about this. Most residents are. That are good residents are, you know, strong. Two out of three, that's all I got. It's not copyrighted, so you're free to go through with that. But. But I do. But I have reflected on that a lot and what's. Met with some varying amounts of enthusiasm amongst my partners. But I think it's true.
- [30:16]
D
Does it matter which 2 out of 3 do you. Would you rather have. Would you rather have someone with one? Since you've thought about it so much, could you pick which two would you pick?
- [30:25]
C
So the. So everybody's different. But the criteria, the end product is. You're judging it on. We'll just say good resident. We'll just. They're a good. They're a solid resident. You would trust them to go in the community to do that. For me, I'd much rather. I'd much rather have someone who is. Has high moral, ethical standards and professional and hard worker because I can make them a better surgeon and I can get them smarter. I can spend some time. That's the most malleable part. Right. So the other two aren't. I can't. I can't make someone who's not a hard worker and I can't make someone who's got some psychosocial issues or some interactional issues easily. But I can make them. So if I've got to pick two out of three. But that really. That's just my preference. You. Some people may feel differently and I'll tell you, if you just list all the residents and say so I'm fine, you'll find that it'll be different, I think.
- [31:18]
A
But I really don't think that. No, I agree because I think that just like you said, a lot of that's teachable. If you have a teachable resident that works hard, they're going to be outstanding. Right. It's being teachable, which is 90%, I think of students coming into orthopedics having the drive and the desire, like everything. We compare everything to athletics in orthopedics. I think it's no different. Most athletes aren't born with. They're not Tiger Woods. But if you want it hard enough, you just need to be teachable and Go home and practice every day and you'll be elite. So you just have to have the drive and the teachability and you'll get there.
- [31:58]
D
Yeah, but isn't it. Isn't it ironic that going back to your point, Lauren, that the thing that's on their application, though is the thing that Jim just said. 90% of your application is made up of the first part of that triad, which is the intelligence and the skills and whatever. And that's what we're evaluating these people on. But the thing we care more about are hard working and. And professionalism, which are like totally intangibles.
- [32:21]
A
No, and I agree. I think what's interesting for those of you guys not in. In resident recruitment, which is my life these days, but we've really. Part one is now pass fail. And they've started signaling us. And I will tell you now that our number of applications has cut in half because students are realizing we're not looking at you if you don't signal us. Our interviews have been so much more interesting because no longer are we looking at score like we don't even use a cutoff anymore because we just look at everyone that applies that signals us, which is about 250, 300. That's probably different HSS met. So you don't have that flexibility. But it's just. It makes for such interesting conversation. I would say we had the most. The strongest interviews that we've ever had this past weekend that I can remember in 10 years when we throw away that board score, which I hate to say they were right, but my gosh, it really. You get for a lot better applicants with a lot more varied background.
- [33:23]
C
You've got more time to assess their emotional intelligence. Right. You're less focused on numbers. Yeah, I make. I wouldn't have. I wouldn't have necessarily presumed that, but it makes sense.
- [33:36]
A
So as we're getting closer to the end, because we only have so much time, I think that one thing I did want to just open up a discussion about is what is it that we could be doing better? Where is it that we struggle? I think we're good at a lot of things, but I think there's a lot for us to learn about how to educate. So. So where do you think we should be putting our time and effort to try to be better at this?
- [33:59]
B
I think I reflect back at my mentor and yours, Lauren. And I feel like Mark used to try to not just put such a focus on educating you and having you become a leader in foot and ankle, but he really did put. And you know that a focus on creating a, a bigger focus on you as a whole person, whether it was a book club or taking you to the opera or yoga or whatever, but.
- [34:33]
A
Really being up and down stairs between cases.
- [34:36]
B
Yes. Or sitting there against the wall so you, you know, you got your legs strong for skiing, regardless what it was, or cooking or different things like that. He really did pick such a individual interest and focus on each person and not just I want to make you a great foot and ankle surgeon. And I. If you're interested in being a leader, I'm going to help you do that. Who are you as a person and what can I do to help? Because especially in residency, in residency it might be different now, but when I was a resident, all you did was work and survive and stuff like that. And so to have people pull out of you, outside of just being a doctor, I think in creating that more well rounded person, I think that in itself I think we could do a better job with our trainees, whether the residents or even fellows.
- [35:31]
C
Yeah. I think to me it boils down to maybe one word. What would be better educators? If we inspire them. Because if we inspire them and set the bar high and model that behavior, whether that's interpersonal behavior with the office staff, whether that's patient interactions, whether that's work ethic, whether it's technical expertise, whether we set that bar high, and if that's our expectations for ourselves, then that's the expectations for them. And so everything that follows, I think and their feedback and I hope that it encourages them to be more active, better learners and ask good questions and be better prepared. And it's harder not to do that if the person you're following is someone who you respect and, and that not you don't necessarily want to emulate, but you want to at least emulate some of those behaviors. Really easy to say, not always easy to do. However. Right. Like most things, I feel going along.
- [36:33]
D
To what everyone else said, I feel like if I think obviously I'm not, I'm couple years to practice, so I'm not inspiring anyone, but I have been inspired. Right. And I want to cut you off.
- [36:43]
C
For two seconds, but I don't think that's true. I think that that can start anywhere and I appreciate your humility, but I think they can start anywhere. But go ahead.
- [36:50]
D
Yeah, that's. That might be true, but I think, I think that if I think back to the best mentors that I have, it goes back to everything that we've been talking or what was just said, it's people who cared about me as a person and just made me think back that Becky, when you said maybe you can't change their character in a year, maybe maybe the best people. Because maybe it's the people who care. I just. Not to disagree or anything, but I just think maybe listening. It just made me think when listening to everyone talk, like, maybe it's the best people who can change like your character and make you a more care. Maybe we can make people more caring. And some. I'm sure there's obviously some people that you can't. But like, my best mentors are people that cared about me and have changed my personality and it's changed how I approach not only honestly, it's not appro. How not not only how I approach like medicine and patients, but how I approach my family and about how I balanced everything being a doctor, which we're not really getting to. But I think there are specific people in residency and then specific people in fellowship and that have really changed to who I am. And those are the people I look up to. And so I think taking a real interest in people and inspiring them and caring about them and taking an interest outside of medicine, maybe that's the way we can be better educators and teachers, because those are like the common thread of people that have been my best mentors.
- [38:04]
B
Agree.
- [38:05]
A
I totally agree. And I think one thing that the. The world of foot and ankle and our community does really well is this idea of mentorship. And that's something I struggle a lot more with the residents because I think my fellowship year with Becky was my favorite year. And that's why I started a fellowship, because I just wanted to recreate that every year. That the bonds you make and the support that you had with common interests I think was so important. And I think that our society tries really hard to elevate everybody, and I find that a lot more difficult. Similar to what you were saying, Matt, about, you know, you have people that aren't interested in what we're doing, and you see them for three months and one of the things they're asking for is mentorship. But it's hard to do when they're not in our specialty and trying to be an ally when you don't have a whole lot in common with them and you see them for three months and you don't see them again for two years. I think that's something that I don't have a right answer because I think mentorship is organic. It's not. You can Assign an intern to an attending. But what are the chances they're going to hit it off and that's going to be the right fit? And I don't have a great answer for it. I think all of us here do it well within our own society but for people outside of it. And that's what brought me into foot and ankle was that feeling in that small group and everyone is included. But I think that's an area where I'm trying hard to get to know my residents, just like you said. And trying to support them in their specialties, which I can only do so much of.
- [39:40]
B
But community.
- [39:41]
C
Yeah. It's easy to say. Hard to do. Right?
- [39:44]
A
Yeah.
- [39:44]
C
Just the secret sauce. The elusive secret sauce.
- [39:48]
A
On our last minutes. Does anyone have any wise words of wisdom for the rest of us? Any last.
- [39:56]
B
I think being an educator is an education itself. I can tell you I think I do a much better job now than I did even 10 years ago. And give yourself some grace in the beginning as well. You. You have to. You, yourself. Individual. We all have. And we've all been educated. We all have mentors. And every single one of them is so individually different. And you have to develop those skills as well. And I have to say how I pick up on the different nuances of my fellows. How I can communicate and how I can teach them now. I hope. I think that I'm so much better than I was 10 years ago and I'll be better than that in five more years. It's just something that we're learning and getting better at with every year as well.
- [40:52]
A
Isn't ironic after how many years of education we haven't been educated on how to educate. It's all a little trial and error.
- [41:02]
B
Yeah.
- [41:03]
C
There's no one formula. Right. I think it happens organically or frankly doesn't happen organically. There's nothing that everybody's got varying degrees of how it develops in their cells. There's a lot that goes into that. Right. Everything from. From ability to desire between. And we're all different. Right. And that's why sometimes it clicks and sometimes it doesn't. Right. With. With learners, I feel educated.
- [41:29]
D
I feel like I just learned so much in this 45 minutes. So that was amazing. So I'm glad. I'm glad I could jump on and learn from everyone.
- [41:35]
B
Thank you.
- [41:36]
C
That was mostly because of my three things. I'm guessing you're saying. Probably right.
- [41:39]
B
Yeah.
- [41:39]
A
You heard it here first. Everyone.
- [41:40]
D
Exactly.
- [41:43]
B
I wrote them down.
- [41:46]
A
The Holmes triad.
- [41:49]
C
There's a lot of Holmes triads. I'm afraid to say.
- [41:54]
A
All right, thank you so much to Jim and Becky for joining us. Thank you, Matt, for asking me to do this. This is something I really am passionate about and still have a whole lot to learn. And thank you to the AOFAS for their continued support of these orthopedic podcasts. Thank you for listening to the AOFAS Ortho Podcast, a Convey Med production. To learn more about joining our dynamic community of highly skilled orthopedic specialists, visit aofas.org.