well stated many times over dtrack22.
you my friend understand the plight of the resident which is easy to understand when you are the student or resident.
PADPM and Kidsfeet: It is very nice of you to volunteer your time and patients to residency training, however it is really a farce if you never at any point take the training wheels off and let the resident go. If you have worked with a resident for 3 years and have done even close to 100 of any type of procedure with them and do not have confidence in them even if they are all thumbs maybe there IS something wrong with your teaching style that they still cannot perform said procedure.
FYI, I do currently have my own patients that I see initially, decide they need surgery, explain the procedure, risks, benefits and alternatives. Have them sign informed consent - me, not my staff - wow just like you 2.
I do not currently have residents so I do not have to share my patients with them. I do think about this often, how I will teach residents, how I will make sure they feel prepared to run their own OR, how will I do this and make sure the patient is not harmed. Oh, wait... that's right... we all took an oath as students to "do no harm" do you think the residents you are working with did not take that seriously? If that is the case, maybe there is a bigger problem that needs to be addressed. What is to say that you would not accidently harm the patient either? Are you not human like your resident?
Luckily part of my residency program has us rotate in a location where we get to experience running the OR. The attending understands the need to train residents and balances this with protecting the patient. We are 3rd year residents during this rotation and said attending trusts the training process. The knife and patient in not handed day one, it is a process and handled differently for each resident, this is called tailoring your teaching to match the resident. It is a sign of a good educator.
Teaching residents is not just about showing up with patients and surgical cases and watching you "perform".
In the words of one of my favorite attendings in residency and not a podiatrist... "Surgery is not a spectator sport". He did not hand me the knife day 1 that I worked with him, it was certainly earned by retracting, anticipating his next step while assisting, writing orders, taking call for his in-house patients. But by my 3rd year when we rotated in his office he would ask what our treatment plan was after evaluating the patient and would often trust our decision on how to treat the patient. Most of these patients had elective procedures and had many years left to enact a lawsuit if desired.
Many times an attending asks how you want to do something, a surgical procedure, your treatment plan... and you come up with a reasonable plan, but it is not the exact way the attending would do it, so the resident becomes wrong. If there is no discussion explaining that the resident's way may have been OK, just not how the attending likes it, the next time that attending asks the same of the resident, the resident does not think for themself how they would do it, they try to guess how that attending would do it. I hardly see this as an ideal way to learn to be a thinking doctor or surgeon. If you want to make a good technician this works great.
Just because you have been a residency director and actively train residents does not mean that you do it right or are the authority on how to do it. You can do something for 50 years the sameway, but if it was wrong the 1st year it will still be wrong in year 50. If you are complacent in your teaching process then you are not improving or advancing, how can you expect the resident to advance when his teacher will not?
