Nothing that is worth knowing can be taught.”
~Oscar Wilde
When I was interviewing for fellowship, one of the fellowship chairman said to me, "in conference we have resident speak, and then there is fellow speak." I was PGY-4 at the time and I really had no idea what he was talking about, but I nodded like I did, of course. It wasn't until I was a fellow that I understood what he was talking about. It is kind of like learning a new language. As you become more experienced, you don't need to think as hard to do the translation. This was extremely obvious to me the other week when I was at a spinal deformity meeting sponsored by an implant company and there was a 2nd year resident (1st year orthopaedic) who was there brought by one of his reps. I looked at him and thought to myself, "does he have any idea what is being said or the complexity of this problem?" I talked to him for a little bit. Then lecture started and the lecturer started using so many acronyms even I had a hard time keeping up with him. I felt that the experience for the young man was probably lost. But, I think he had a good time and meet some important people in the field. What this gentleman and many young surgeons failed to realize is that this is what I would call an "adult swim" area of orthopaedics.




"So, what is this adult swim you speak of?"

What I refer to as adult swim are surgical topics and procedure that require a high level of understanding than you can get from an orthopaedic or a anatomy text book. This refers to an understanding that can only come from experience. It comes from already being there and understanding the difficulties of the particulars of the specific problem. It humors me to hear medical students and young residents discuss a surgeon’s technical ability when they have no true understanding of surgical techniques and complexities of a case or procedure. An artist's rendition of a procedure NEVER does it justice and makes it always seem simpler than it may be. You know adult swim when the surgeon says, "let me show this to some people." Then when it is shown, the response is, "yeah, let me know how that goes." These are not resident cases.

So for me, there are cases that I feel are cases that a resident an X level should be able to do with adult (STAFF) supervision. Then there are other cases when I look at the resident across from me and say, "time to get out of the pool, this is adult swim, only."

“I know what I have given you. I do not know what you have received”
~Antonio Porchia

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