“Whatever we learn to do, we learn
by actually doing it; men come to
be builders, for instance, by building,
and harp players by playing the harp.”
Igroaned. "Don't make me operate with him again! I assisted him in surgery just last week!" I was low man on the totem pole and there was
no point arguing. All of the residents and fellows kept
track of the rotation and I knew it was, indeed, my turn.
"What torture!" I whimpered as trudged off to the operating room.
So, why did I resist working with this particular surgeon? After all, he was a renowned expert with impeccable credentials. He was well-trained. He worked hard and was never abusive.
He always performed interesting procedures and his approaches were
The problem was that he was hopelessly disinterested in teaching.
One day, for example,
I scrubbed in with him.
The patient had large facial
cancers and would need
extensive removal of skin
and major reconstruction.
Given the extent of the disease, I knew that the case
would take several hours to
As I got to the operating room, I reintroduced myself although we
had met before in conferences. "Doctor, I'm Bruce Campbell," I said.
"I am one of the new fellows. I am looking forward to scrubbing with
He nodded and mumbled, "Hello." That was the last direct verbal
interaction all day.
The patient was prepared and the surgery was soon underway. For
several hours, I stood across the table from the prominent surgeon
and watched. He performed every single maneuver of the procedure
from making the first incision to placing the final stitch. When he
needed something retracted, he asked the scrub tech to hand him the
appropriate instrument. He then placed the retractor
in the incision and pointed the back end of it toward
me, indicating I was to grab the retractor and pull.
If it slipped or I tried to move it so that it might
offer better exposure, he grunted, shook his head,
and moved the instrument back to where it had
And so it went all day. He worked through areas
with interesting anatomy, none of which he described.
He changed his approach a time or two without
revealing his thoughts. He never offered to show me
what he was seeing or stopped to say, "see how this
feels here," or "take the knife and dissect this." He
When the case was over, he placed the dressings
and secured everything with surgical tape. He pulled
off his gloves and left the room. I stayed behind to help transfer the
patient to the Recovery Room and complete all of the postoperative
paperwork. I was seething.
I realize, of course, that every patient has the right to expect that the
senior surgeon will perform their surgery even in academic teaching
hospitals. This expec-
tation is probably even
stronger now than it
was during my training,
thanks to the Internet
and the popular medi-
cal shows on television.
Yet, every operating
room is potentially a
It has been so for generations. This is the place where the next cohort
of surgeons safely learns what to do and, more importantly, what
not to do.
I look back on my experiences with the disinterested teacher with
sadness. What more might I have learned? I observed his techniques
but never understood why he approached cancers as he did.
I continued my training program determined to be a teacher as
well as a surgeon when my turn finally arrived. That has been a goal
throughout my practice, and I hope I will be remembered as a surgeon who loved to teach, benefiting not only my own patients, but the
patients of my trainees far into the future.
Teaching (Or Lack Of It) In The
Operating Room Today
Every OR is a potentially wonderful classroom. It has been so for several generations.
“I hope I will be remembered as a surgeon
who loved to teach, benefiting not only my
own patients, but the patients of my trainees
far into the future.”
Bruce Campbell, MD,