Podcast Summary: AOFAS Orthopod-Cast – "Incorporating Teaching Strategies Into Your Practice"
Date: December 31, 2024
Host: Lauren Gainey (A), University of Connecticut, with Dr. Conti from HSS
Guests:
- Dr. Becky Serato (B), Mercy Medical Center, Fellowship Director
- Dr. Jim Holmes (C), University of Michigan
- Dr. Matt (D), early-practice educator
Main Theme
This episode explores how foot and ankle surgeons who are also educators can effectively incorporate teaching strategies into daily practice. The panel discusses practical methods for assessing and advancing learners, providing meaningful feedback, fostering mentorship, and addressing professionalism. The conversation reflects on the evolution and challenges of surgical education in foot and ankle orthopedics.
Key Discussion Points & Insights
1. Pathways Into Education
[01:20] B: Dr. Serato shares that her move into academic medicine “happened organically”—her enjoyment during fellowship and an open position led to her long-standing educational role. ([01:20])
- Quote: “It was just something I enjoyed so much and I could just see myself in that role.” (B, 01:37)
[02:24] C: Dr. Holmes describes 19 years in private practice where “the surgery became like factory work…a little bit stale” before he transitioned full-time to a university role for more stimulation and challenge. ([02:24])
2. Assessing New Learners
[04:05] B: Addressing how to assess new fellows, Dr. Serato emphasizes:
- Scheduling “softball cases” early for skill evaluation
- Allowing extra time in early cases for hands-on engagement
- Recognizing the broad variability in backgrounds and skills
- “You really don’t know what their skills are until they put the knife in their hand.” (B, 04:38)
3. Graduated Autonomy & Operative Planning
[06:15] C: Dr. Holmes stresses that autonomy in the OR starts before surgery with written operative plans and pre-op discussions.
- Level of autonomy is “hurdle-based”—preparation, knowledge, and enthusiasm are crucial.
- “If they’re prepared and enthusiastic and demonstrate a knowledge of the anatomy, it’s going to be a good day in the operating room for me.” (C, 07:53)
4. Teaching the Unmotivated or Non-Specialty Resident
[09:08] B: It’s essential to actively engage residents not planning a foot and ankle career:
- Involve in case conferences and give them ownership over interesting cases
- Tailor learning to their interests (e.g., sports, trauma)
- “You really need to get them involved in the thought process.” (B, 09:34)
[12:07] A: Practical teaching in soft-tissue handling and clinical decision-making is universally valuable.
- “The thing I think that we can teach them that no one else can is tissue handling, because that’s such an important thing.” (A, 11:44)
5. Effective Feedback: Frequency and Approach
[14:26] B: Regular, non-confrontational feedback is key—not just at the end of rotations.
- Shifting from semi-annual, summative reviews to weekly or real-time check-ins
- “They want honesty. So what I’ve learned... is you have to figure out how you do best... But we can sit here and talk about that week and I think that helps them a little bit better.” (B, 15:09)
[16:57] C: Real-time, specific feedback in the OR and clinic is most constructive.
- Avoid only written feedback at the end: “I think we’ve done them and ourselves a disservice.” (C, 17:39)
6. Addressing Struggling Learners & Red Flags
[18:59] B: Early, targeted intervention for performance or judgment issues is essential.
- Focus on documentation and diagnostic acumen, not just surgical skill
- “If you wait, then I just think that’s going to be an unsuccessful outcome... That’s not fair to them either.” (B, 21:03)
[21:04] C: Watch for repeated mistakes after feedback, minimization of complications, or dishonesty as red flags.
- “Making the same mistake two or three times... that is a red flag.” (C, 21:31)
7. The Challenge of Professionalism
[23:26] C: Professionalism trumps intelligence and skills; it’s the hardest and most important trait to assess and teach.
- “You can train a lab monkey to operate, but you can’t train a lab monkey to indicate procedures, manage complications.” (C, 23:41)
- Selection should focus on “screening out” those with likely professional issues.
[25:54] B: Application materials rarely reveal professionalism concerns, and it’s difficult to alter personality within a fellowship year.
8. The Holmes Triad (Three Scales for Assessing Learners)
[27:32] C:
- Intelligence (and technical/academic ability)
- Work ethic (drive, effort)
- Professionalism/affability (team fit, character)
- “The rock stars...are all three... Most residents are two out of three...” (C, 29:10)
- If forced to choose, work ethic and professionalism are preferable: “That’s the most malleable part. Right. So the other two aren’t. I can’t make someone who’s not a hard worker...” (C, 30:25)
9. Changing Selection, Redefining Merit
[32:20] A: Newer “pass/fail” board exams and the elimination of score-based cutoffs shift focus onto holistic characteristics like emotional intelligence and background, improving the quality of interviews and applicant pool.
10. Being Better Educators & The Role of Mentorship
[33:59] B: Creating well-rounded individuals—focusing on the whole person, not just the surgeon—leads to more effective mentorship and better outcomes.
- Mentorship must be individualized and authentic.
[35:30] C: The central goal is to “inspire them”—by modeling high standards and caring for the learner as a person.
[36:33] D: The most influential mentors demonstrate genuine care for their trainees beyond academic interests, affecting not just clinical skills, but broader life and interpersonal dynamics.
Notable Quotes & Memorable Moments
On Assessing Skill
“You really don’t know what their skills are until they actually put the knife in their hand.”
— Dr. Becky Serato [B], (04:38)
On Fostering Engagement
“You really need to get them involved in the thought process.”
— Dr. Becky Serato [B], (09:34)
On Teaching Value Beyond Foot and Ankle
“The thing I think that we can teach them that no one else can is tissue handling, because that’s such an important thing.”
— Lauren Gainey [A], (11:44)
On Feedback Delivery
“It is so much easier now that I have been doing it almost on a weekly basis.”
— Dr. Becky Serato [B], (16:36)
On Professionalism and Selection
“You can train a lab monkey to operate, but you can’t train a lab monkey to indicate procedures, manage complications…”
— Dr. Jim Holmes [C], (23:41)
The Holmes Triad
“Three scales that you can assess people on… intelligence, work ethic, and professionalism or affability.”
— Dr. Jim Holmes [C], (27:32)
On Growth as Educators
“Being an educator is an education itself… I think I do a much better job now than I did even 10 years ago.”
— Dr. Becky Serato [B], (39:56)
Timestamps for Key Segments
- [01:20] – Panelists’ paths into academic medicine
- [04:05] – Assessing new fellows and residents
- [06:15] – Granting autonomy and operative planning
- [09:08] – Motivating and teaching disinterested residents
- [13:56] – Feedback challenges and strategies
- [18:59] – Spotting and intervening with struggling learners
- [21:04] – Identifying red flags in trainee performance
- [23:26] – The central importance of professionalism in selection and training
- [27:32] – The Holmes Triad for evaluating trainees
- [33:59] – Pushing education beyond technical knowledge—whole person mentorship
- [39:56] – Advice for aspiring educators; the ongoing journey to improve as a teacher
Reflections & Closing Thoughts
The panel concludes that surgical education is a constantly evolving effort requiring educators to adapt, reflect, and recognize their own growth. Regular, thoughtful feedback, authentic mentorship, and a willingness to look beyond test scores to personal attributes are central to developing the next generation of surgeons. The participants agree that the “secret sauce” for effective medical education is elusive, often organic, and grounded in commitment to the learner as a whole person.
Summary prepared for educational purposes; all quotes attributed by speaker and timestamp.