Techniques in Foot & Ankle Surgery:
One day an apprentice, the next day a master: This time of year, residents find places to practice on their own as independent surgeons. However, it is not as when a butterfly emerges from its chrysalis and flies away alone. Residents learnt to fly solo from time to time, albeit with supervisors nearby. When it comes to training our surgeons, how does one prepare for the transition? Increasingly, direct supervision is mandated, requiring teachers to be at a procedure at all times to protect against substandard care or giving the trainee latitude beyond which safety is not assured.
Nevertheless, the transfer of responsibility and the transition to independent practice has to occur. It is a gradual and graduated process. A prudent teacher gauges a trainee’s readiness at each level of care or responsibility. Too much too soon is detrimental to care; in contrast, too little too late interferes with a trainee’s development. Mental faculties may not be stressed or alert enough when there is a subconscious awareness of, or reliance on, someone more skilled, knowledgeable, and responsible hovering. Thinking on one’s feet is not fully developed until one gets the feeling of sole responsibility. It is a different experience to be “up the creek” without someone else there to help paddle, negotiate the complicated, and plan ahead for challenges or hurdles. The teacher is entrusted to prepare the trainee for such eventualities. Further, patients and payers entrust their care to and rightly expect care by a fully trained physician. Patients ask, “Will you be the one who will do the operation?” Most are, however, accepting of trainees involved in their care. After all, trainees are the teachers of the future. Teachers themselves gain the necessary skills and wisdom over the years and become astute in striking the right balance between training and safety in delivering care. They are responsible not only for the care they provide in the present but also, through their trainees, for care in times to come. And thus the cycle continues. One day everyone experiences the big day, the day of transition to independent practice—the metamorphosis.
For those on the solo flight or soon to experience one, there are plenty of resources for help. They can still seek remote help from their former teachers. There are resources such as this journal, with techniques described in great detail, providing the map and the light for their journey from renowned authorities and innovators who are forever improving care.
We are fortunate to have Peter Mangone and Jorge Acevedo serve as Guest Editors for this issue and other authorities who describe their surgical techniques in great detail. Through this issue as well as through others in the past, this journal provides a great resource for those who are venturing out of training and also to those seeking to be at the cutting edge.
Vinod K. Panchbhavi, MD, FRCS, FACS