In many academic medicine situations (and others in Fire and EMS) the immediate supervisor, or slightly more senior provider is often the one teaching the novice something. This is often a matter of expediency since in the middle of the night, the attending, Chief, etc is not there to teach. But I worry that in many disciplines, learners never see a real expert do something. An example is in some mid-level operating room procedures. In many of these the senior resident is taking the junior resident through the case with the attending watching. In those cases, it is likely that the junior resident’s only experience with the procedure is having watched another junior resident taken through the case by another senior resident.

Thus, that junior resident, and possibly the senior resident, have never watched someone who has done 100 of these cases perform the case. There are a lot of things that can be learned by watching an expert do something. I remember my experience from a rotation at a private hospital during my residency. At this hospital, the residents were often first assistants to the attending surgeons. It was the first time I first assisted in my residence on major operations (since usually the attending first assists the senior resident in major cases in academics).  It was very eye opening. Expert surgeons have a different way of proceeding through a case, it appears more like a task than an adventure. They go from task A to task B to task C with little wasted motion. They know the next step and they anticipate it, sometimes moving my hands so I could begin to expose for the next step, since they didnt need the exposure for the step they were on. Anticipation and pre-planning were evident and really moved the cases along. Also since they knew the anatomy, and how to separate structures, there was less bleeding. If theres less bleeding you can see better, and the case moves quicker.

I have told my senior residents that you don’t operate fast by operating fast. You operate fast by knowing what comes next and making sure you’re prepared for the next step, and by taking your time during the critical steps to make sure you get it right the first time. There is a great phrase “there is never enough time to do it right, but always enough time to do it over” that applies. Doing something quickly and wrong takes far more time than doing something slow and correctly.

If you have the opportunity to be with someone with a great deal of experience, watch the way that they do things, not just with their hands, but how they think, how they anticipate, and how they plan the next step. Sometimes great commanders do this in such a way that it is transparent (going to get a stretcher, a piece of equipment, making a radio call for more help before needing it , etc.). Taking the time  to talk to experienced people, understanding why they do things the way they do, and taking their path through a problem can enhance your education in any field.