See one, do one, teach one
Replace blind case-counting with deliberate, structured practice.
The old apprenticeship maxim, see one then do one then teach one, comes under scrutiny here. With the traditional firm structure gone, case volume has become a crude stand-in for skill, yet not all cases are equal. Cannulating a fit young adult is nothing like cannulating a frail dehydrated patient or one in cardiac arrest. Citing Birkmeyer's study of bariatric surgeons, where peer-rated technical skill predicted complications, the authors stress that early cases and good demonstrations carry disproportionate weight. They use learning curves to question easy assumptions about durability and thresholds, then offer remedies: rating case difficulty, spaced repetition, breaking procedures into micro-skills, simulation and humility when judging your own competence.
Three takeaways
- A case count hides how much more the harder cases teach you
- Break procedures into micro-skills and rehearse them off the patient
- Skill needs lifelong feedback, experience alone will not deliver it
Reflection
Questions for this chapter
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