|How Surgeons Acquire Experience – by Dr. Rubinstein|
From: “drpugs” Sent: Sunday, June 10, 2007 2:53 AM
Subject: THE FIRST HUNDRED
Hi All,Just catching up after not having time since the end of may. I noted many posts on the number of cases (a new surgeon) needed to become proficient. Some mentioned it being bogus to learn on patients and other similar comments.
I ask everyone to consider that everyone needs to start somewhere and all surgeons (even Gross, DeSmet and McMinn) had to do their first resurf and their next 99 prior to reaching 100.
This issue is one that is difficult for me because I set very high standards for myself and always want to do the best thing for my patients. That is why I became interested in the resurf concept. As I went through my first 50 cases I was always questioning my experience and analyzing the results to be sure I was doing the best surgery I could. On the one hand you know you don’t have the experience that some others do. On the other hand there is no way to get it without doing the cases. It is a very difficult issue for a surgeon.
I resolved it by training as follows. 1)observing surgery with three different resurf surgeons. (Gross, McMinn and Stachniw)prior to doing my first case. 2)Taking the formal BHR training course. 3)Carefully selecting my early cases to be straight forward. 4)Carefully reviewing each case looking for ways to improve.
While I realize the importance of experience as I hope most of my fellow surgeons do we all must start somewhere. There is really no way to resolve that issue.
As for an individual deciding where to have the procedure done there is no easy answer. I would make sure first that you are comfortable with the surgeon and your experience on your visit. Ask questions and be comfortable with the answers. If you don’t have a good feeling look elsewhere.
If you personally set a minimum number of cases for your surgeon that’s fine. But please don’t insult the surgeons starting out by claiming them to be bogus. Most are like me when I started. Worried to death about doing a perfect performance every time while starting a new and difficult procedure. Doing their best each and every time and beating themselves up for every mistake no matter how minor. Ask my wife and she will tell you how much it bothers me every time something doesn’t go perfect in surgery, even if it is something that won’t affect the results. I take the responsibility and trust that patients give me very seriously and I feel the majority of the orthopods do.
I hope that will give you all some insight into the moral dilema that faces a surgeon starting with a new procedure. If some of us don’t learn and gain experience in resurfs then the procedure won’t be widely available and many resurf candidates will lose their heads needlessly due to lack of qualified surgeons.
Remember we all had to crawl before we learned to walk and then stumbled unsteadily before we learned to walk well. Thanks for reading this ramble.
Scott Rubinstein M.D.
Illinois Bone and Joint Institute, Chicago, Illinois