Guest Editorial perhaps I should’ve chosen an alter- How to Pitch the native career path! All orthopedic surgeons will acknowledge the obvi- ous development and evolution of ‘‘Perfect Game’’ surgical skill and judgment that prog- ress during the years of Residency and Fellowship, but it also is critical Jess H. Lonner, MD that we continue to improve and refine our surgical craft after training through a process of self-evaluation hiladelphia, the city in which I practice orthopedics, also boasts and deliberate practice. How do we a remarkable 32-year-old pitcher, acquired before the start of the stay on top of our game? 2010 season, named Roy Halladay. I was intrigued by an article1 Mentoring by senior or more that I read about the great athlete at the start of the season and experienced partners is an invaluable found certain relevance to what we might do to develop and hone method of continuing education that Pour surgical skills. Although he is considered by many to be one of the elite few of us appreciate or capitalize pitchers of all time (he thrilled us this year with a “perfect game” and only 4 upon, either as mentor or mentored. pitchers have a better winning percentage since the year 1900), it seems that he The potential benefits of having a wasn’t drafted particularly early, and, at one point, mentor for junior surgeons are obvi- at the age of 23, he was sent down to Class A ball ous, but even the mentor may benefit by his former major league team because he was from the relationship with a more underperforming.1 This adversity ignited in him a junior partner who may offer insight passion and drive to improve his skills and work his into fresh ideas, concepts, and tech- way up to the top. The story about his efforts and niques. Be willing to break down work ethic brought to mind something that Geoff conventional hierarchal barriers. Colvin would call “deliberate practice,”2 meaning a Residents, Fellows, and Physician concerted, focused effort to work to develop one’s Assistants often ask the most chal- competence in a given field, sport, or endeavor. “If we don’t lenging questions and sometimes Colvin’s argument is that raw “talent” only would have the best suggestions for surgi- get us so far, but not to the pinnacle of our potential. advance and cal techniques, naïve or not. These While reading the article about Halladay, ‘practice’ colleagues also often work with other I wondered what orthopedic surgeons can do surgeons who have different tech- after Residency and Fellowship to “practice” our while in niques, and conversation about those trade—to become the best. We all have that quirky ‘practice,’ procedures and differences should be family member or friend who jokes that they don’t a natural curiosity that is not inhib- want to go to a doctor who is still “practicing,” we run the ited by a possible threat to one’s ego. using the obvious play on words. But really, how risk of becom- Encourage critique from your do we keep our skills sharp or, better yet, refine operating room team. Consider a our skills to learn new techniques and methods of ing stale.” postoperative debriefing with those surgery and fulfill our ultimate potential? If we who observe your surgery, who have don’t advance and “practice” while in “practice,” seen others do similar surgeries, and we run the risk of becoming stale or, worse yet, obsolete. I remember back who do not feel threatened by provid- 20 years ago feeling rather unimpressed with my own surgical skills as I ing honest feedback regarding your tried to sew a couple of flimsy pieces of Swiss cheese together during an cases. I often recall fondly an invalu- interview for Residency at a prestigious orthopedic hospital and wondering if able experience after I had joined a new practice over 9 years ago. One Dr. Lonner, this journal’s Associate Editor for Adult Reconstruction, is Director, Knee of our operating room nurses pulled Replacement Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania. me aside after a few days of surgery and respectfully asked whether he Address correspondence to: Jess H. Lonner, MD, Director, Knee Replacement could point out what he thought Surgery, Pennsylvania Hospital, 800 Spruce St., Philadelphia, PA 19107 (tel, 215-829- were inefficiencies. Needless to say, 2461; fax, 215-829-2478; e-mail, [email protected]). I genuinely appreciated the offer and Am J Orthop. 2010;39(10):474-475. Copyright Quadrant HealthCom Inc. 2010. All was delighted that he and other mem- rights reserved. bers of my team have had no problem 474 The American Journal of Orthopedics® Guest Editorial stepping over traditional job descrip- who understand the need to educate recognize that our time in the major tions and boundaries. Incidentally, I surgeons in practical skills and not leagues is limited. We should train incorporated some of his suggestions just theory. I’ve had an opportunity to hard to refine our pitches, have our then and still consider his insight of teach a large number of cadaver-based teammates and coaches make sugges- value today. courses over the years. While the tions and critique our performance, Preparation and repetition help courses are valuable for skill develop- collaborate with an experienced refine surgical skills, making it logi- ment, for many, the training should be coaching staff, and understand why cal to conclude that those of us who extended and repeated. I encourage we sometimes throw balls and figure “super-specialize” have more oppor- surgeons with limited experience with out how to improve our performance tunities to become highly proficient certain procedures to take courses so that, ultimately, we might throw because of the volume of cases. I several times to optimize surgical the ideal strike. I don’t personally certainly would struggle at this point skill development. From a selfish per- know “Doc” Halladay, as he’s nick- around a spine or shoulder. But sim- spective, as enjoyable and rewarding named, but I suspect he would agree. ply repeating surgical procedures as it is to teach courses, they also does not make surgeons stay atop the often are a tremendous vehicle for my AUTHOR’S DISCLOSURE mound. Self-evaluation of techniques own personal edification and ongoing STATEMENT from videotaped surgeries can give education. I’ve been honored to teach Dr. Lonner reports no actual or potential us valuable insight into our perfor- cadaver labs with skilled surgeons conflict of interest in relation to this mance, and this window can help us with names like Caborn, Rand, and article. eliminate inefficiencies and poten- Wood and have taken full advantage tial errors, ultimately improving our of our time together to pick their REFERENCES game. Having a partner or mentor brains, study their techniques, and 1. Verducci T. This might hurt: Roy (Doc) critique our performance requires a gain insight into their approaches and Halladay operates in Philadelphia (sorry, sound ego balance, but can help fur- thought processes. National League). Sports Illustrated. ther refine our surgical techniques. So how do we “practice?” How 112(15):44-51. Surgical skills courses are do we keep ourselves at the top of 2. Colvin G. Talent is Overrated: What Really offered by the American Academy our game? The answer of course, is Separates World-Class Performers From of Orthopaedic Surgeons, specialty preparation, deliberate practice, self- Everybody Else. New York, NY: Penguin societies, and implant manufacturers awareness, and critique. We should Books; 2008. 2010 Resident Writer’s Award he 2010 Resident Writer’s Award competition is sponsored through a restricted grant provided by DePuy. T Orthopedic residents are invited to submit technique papers, tips of the trade, original studies, review papers, or case reports for publication. Papers published in 2010 will be judged by The American Journal of Orthopedics Editorial Board. Honoraria will be presented to the winners at the 2011 AAOS annual meeting. $1,500 for the First-Place Award $1,000 for the Second-Place Award $500 for the Third-Place Award To qualify for consideration, papers must have the resident as the first-listed author and must be accepted through the journal’s standard blinded-review process. Papers submitted in 2010 but not published until 2011 will automatically qualify for the 2011 competition. Manuscripts should be prepared according to our Information for Authors and submitted via our online sub- mission system, Editorial Manager®, at www.editorialmanager.com/AmJOrthop. Through a restricted grant provided by Advertiser Index October 2010 475 Advertiser Index The American Journal of Orthopedics Innomed, Inc. 313 2010 Resident Writer’s Award Program 356 Schering-Plough Supplement: “The 25-Year Experience Celestone® Soluspan® Cov 2-309 With the Natural-Knee® System” 346 Xanodyne Pharmaceuticals, Inc. CME Webcast: “Achieving Guidelines-Based Zipsor™ 317-318 Care: Preventing Venous Thromboembolism in Orthopedic Surgery Patients” 349 Zimmer, Inc. Continuum Acetabular System 311 American Regent, Inc. Betamethasone Sodium Phosphate and Natural Knee System 315 Betamethasone Acetate 323-324 Uni High Flex Knee 338-339 Ferring Pharmaceuticals, Inc. Euflexxa® Cov 3-Cov 4 Fitmore Hip Stem 345 356 The American Journal of Orthopedics®.