Mentoring, consistent training essential for reaching surgical excellence

Without strong motivation, it is unlikely that fellows and recently graduated fellows will improve and excel in minimally invasive gynecologic surgery (MIGS).

“What lights you up?” asked Javier Magrina, MD, a professor of ob/gyn at Mayo Clinic Arizona in Phoenix, who was part of a panel on pushing the surgical envelope from dream to reality at the American Association of Gynecologic Laparoscopists (AAGL) 2020 Virtual Global Congress.

Javier Magrina, MD

“You need to set up clear objectives for yourself and create a path to follow,” Magrina told Contemporary OB/GYN of fellow and recently graduated fellows.

As part of that path, a good mentor to whom one relates well is essential. “If you do not improve, apply cognitive therapy: keep asking yourself why I am not improving until the answer surfaces,” Magrina said. “Ask your mentor if you do not find an answer.”

However, if you do not trust the mentor, “find another one,” Magrina said. “In sports, private coaches are hired and fired, based on the growth of the athlete.”

Likewise, hands-on courses improve surgical skills, especially when they include cadaver dissections.

Magrina also encourages surgeons to envision surgical techniques in their mind. “Close your eyes and see every tiny aspect of the operation,” he said. “When you have a complete and detailed imaginary video, you will be in the zone during the operation.”

Analyzing plenty of real surgical videos is helpful as well, both one’s own and videos of others’ surgeries to compare techniques.

“In short, excelling in surgery demands unrelenting dedication and never stopping,” Magrina said. “There is always something new to learn from someone and incorporate.”

Magrina said none of the information presented should come as a surprise to recent graduates who wish to excel, other than for those who are content with the training they received.

“It would be an improvement if the American Board of Obstetrics and Gynecology (ABOG) mandated hands-on skills testing for everyone at the time of the written exam and a review of their surgical videos at the time of the oral board exams, followed by re-evaluated performance every 10 years with a review of their surgical videos and hands-on skills,” Magrina said. “But this will take time and a lot of discussion.”

Meanwhile, Magrina believes it is important that surgeons discuss the benefits of knowledge and skills. “You need both to be a good surgeon,” he said. “It is a matter of patient safety.”

Being a safe surgeon entails learning anatomy, diseases, and the surgical technique for each disease.

Committing to the laparoscopic lab or the console three times a week for 20 minutes per session is better than one single hour a week, according to Magrina.

“Remember, never give up,” he said. “Great things take time. Never quit learning.”

Also, surgeons should become highly focused in one area of expertise because “you cannot be an expert in all operations,” Magrina said.

To embark on a new procedure, the surgeon should learn anatomy first, followed by exhaustive preparation, then perform the procedure on a cadaver. “When satisfied, you can proceed to the OR to perform the actual procedure, preferably with an expert,” Magrina said.

Valuable lessons can also be gleaned from major surgical complications. “If you do not learn from a complication, then you have failed,” Magrina said. “In fact, your best teacher is your last complication. You have an opportunity to learn from every complication.”

Lastly, to continue growing in a surgical career, the surgeon needs to determine for himself/herself whether a new technique is valid. “Do not take someone else’s word,” Magrina said.

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Disclosures

Magrina reports no relevant financial disclosures.