Make No Assumptions, Give Lots of Tests

Abstract

As a young staff surgeon and general surgery program director at the Mayo Clinic in the mid-1990s, I had an “Aha!” educational moment: I worked with a solid trainee performing a thyroidectomy as a first case on M-W-F of that first week. I assisted the intern in doing much of all 3 cases. On Monday he had no idea how to ligate in continuity and divide the middle thyroid vein. “It is an important technique,” I said. The intern nodded and responded, “I like it.” On Wednesday we again got to the stage of mobilizing the thyroid lobe out of the neck, and I asked my trainee, “How are we going to take care of the middle thyroid vein?” The intern responded, “I am not sure.” I then proceeded to help him ligate in continuity: verbalizing how to grasp the vein, dissect posterior to it, and pass two 3-0 silks. We each tied our own silk ligature and he divided the vein and trimmed the 3-0 silks. “Oh, now I see.” On Friday, same operation, same blank look when we came to the middle thyroid vein. He had no concept of ligation in continuity. After helping him do it for the third time that week, I proceeded to give him some politely worded, but negative, feedback, which included me saying he didn’t remember any of the 5 steps I taught him about ligation in continuity. I closed with, “Do you understand my feedback to you?” He nodded his head and said: