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An Old Dog Learns a New Trick

Shin, Alexander Y. MD

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Techniques in Hand & Upper Extremity Surgery: March 2020 - Volume 24 - Issue 1 - p 1
doi: 10.1097/BTH.0000000000000263
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Learning a new surgical technique can be rewarding for both the surgeon and the patient. For the surgeon, learning a new technique is not only mentally stimulating, but it can also provide a marketable skill. For the patient, the new technique may be the advancement in hand surgery that improves their outcomes and minimizes rehabilitation or complications.

New techniques are in residency or fellowship training are traditionally taught by observing a mentor surgeon perform the surgery with close observation, followed by performing the surgery with mentor oversight and supervision, followed by advancement to performing the surgery with diminishing oversight. However, as attending surgeons, the opportunity to be guided intraoperatively by a mentor is not always possible. In these situations, surgeons attend didactic courses, surgical skill cadaver courses, or visit centers where the new surgical technique occur.

I was recently at a meeting when a surgeon asked me “how does an old dog learn a new trick?” followed by “specifically, how do you learn a new surgery?”

After thinking about his question, I told him that the key was attitude, education, teaching, and practice.

Often times, when a new technique is presented, there is initial suspicion and negative comments made of the technique. There is a need for the surgeon to keep an open mind and to have the attitude that perhaps there is something in the technique that they could take away for the improvement in the care of their patients. Although all new techniques may not be applicable, portions of the technique may be very beneficial and allow for refinement in the surgeons current technique.

Learning new surgical skills is dependent on both the surgeon’s experience and the level of complexity of the cases the surgeon typically performs. Some experienced surgeons can read about a new technique and execute it flawlessly, whereas others observe it once and can perform the surgery flawlessly. The common denominator in these surgeons is their surgical experiences (both successes and failures), exceptional fund of knowledge (obtained through reading, attending conferences, watching surgical videos, participating in surgical skills courses), and their thirst for continual advancement and knowledge.

When surgeons teach a technique, they often see and learn the pitfalls of the surgery not necessarily seen when not teaching. The third-person view of teaching allows surgeons to question why they do certain steps or maneuvers. When teaching a resident/fellow, it allows surgeons to learn from their mistakes, and if the dialog is open, the resident/fellow can point out the mistakes of their mentors.

New techniques are not a once and done surgery. They need to be adapted to the surgical skills of the surgeon and the needs of the patient. This can only be done with careful practice on cadavers with advancement to humans when perfected.

In reflecting back, it is not just “old dogs learning new tricks” but “all dogs needing to learn new tricks” to continually improve themselves and their techniques for the betterment of our patients. I am hopeful that the techniques presented in this journal will allow surgeons to gain new techniques and improve the outcomes of their patients.

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