How often does a podiatry attending (or any surgical attending) perform surgical procedures that they did not do skin to skin while in residency? I'm not talking about someone who has been in practice for 20 years, but say only 1 or 2 years as an attending.
I can't help but notice many residents log high numbers, but often are just retracting and maybe helping to close the skin. For the attendings practicing today, did a lot of them have to figure it out on their own after residency?
Very good topic and questions. Here's my take on this as someone who just completed their training and started practice:
In my humble opinion, you need both elements to become an excellent surgeon. You need to be able to observe and understand what you're observing as well as the physical exercise of surgery. Allow me to expand further - Surgery is a mosaic of art and science. The science is what you learn as a pre-clinical student, clinical student, and especially resident (and fellow). The science is your foundations and basics. If you don't have the foundations then you cannot and should not attempt to operate, even if you have the best hands as a surgeon.
This brings me to the next component which is the "art". The art needs to be mastered through physical exercises, dexterity, and skills. Again, there is a spectrum for that starting from basics and fundamentals i.e. sutures, hand-ties, etc. and ranging to understanding AO principles for fixation. Once the fundamentals are demonstrated, only then can we move on to the more advanced techniques. A lot of the fundamentals can be learned on your OWN time and it should be - i.e. make the time to practice hand ties and sutures at home and taking time to go to the cadaver workshops even to learn something as basic as holding the knife and forceps. Bone saw workshops are also great for young/new residents to understand the "feel" of throwing screws and securing fixation. Again, once the fundamentals are established, building on them becomes a matter of exercise and dedication - just like learning a musical instrument. You won't play Beethoven's classics on your first swing at a Piano but it takes dedication/practice and lots of it.
As for the observation of residents "retracting" versus residents "operating" - here's my take on that: When I was a resident, I worked with some attendings who did not let residents do more than skin closure. At first, I thought this was frustrating but eventually I learned their system and learned why the operate the way they do by shear observation. I was engaged and involved. By understanding the steps, I was able to eventually operate on their patients under their guidance - but this took time.
When I was a fellow, I spent time with Sig Hansen's former fellows and I personally observed him as well in his OR. He did the bulk of the procedure and they observed. Again, the notion here is that fellows are advanced in their training and by taking the time to observe his subtle steps and methods, you're able to absorb a significant amount of detail. I was able to take that knowledge and learn to apply that with what I already knew as a surgeon.
As for attempting procedures without prior training - I think the answer will again be "it depends". If you do not understand the principles of that surgery and are not comfortable surgically/medically managing the potential complication of the surgery, then you should not attempt it. Perfect example would be Total ankle arthroplasty surgery. If you haven't had experience training or performing that procedure, and are not comfortable handling not only the execution but potential complications, then you have no business thinking about performing it.
However, if you're performing a midfoot fusion for example and do understand the principles and surgical management of the complications then you can perform it because chances are you've done other fusions in the foot/ankle as a resident i.e. ankles, hindfoot.
As a new attending - I'm using a lot of what I learned from both residency and fellowship in the OR, patient encounters, and even billing. Although, I've been fortunate to have comprehensive training and experience, I'll be first to admit that I'm also learning and modifying what I've learned to fit my patient needs. You'll find that in residency and training in general, you're offered a variety of options and approaches but it doesn't really "click" until you're practicing on your own.
Good luck.
