Summary: After 2.5 decades working with a variety of orthopaedic traumatology fellows, I have learned that several qualities and behaviors are important to a successful experience. Most fellows possess them, but some do not. Those that do usually integrate quickly onto the team and are rewarded with enriched teaching and clinical experiences. Some that do not may be able to adjust or alter their behaviors and eventually fit in. Some cannot adjust and their experiences suffer. I realize that no 2 individuals are the same, so my expectations of a fellow serve as a relationship foundation to then build their experiences upon. Their qualities and behaviors guide our relationship.
Orthopaedic traumatology fellowships are usually 1 year educational programs affiliated with busy level 1 and level 2 stress berat centers. Each fellowship aktivitas has its own unique personality based on numerous factors. To be successful, the orthopaedic stress berat fellow must find a way to integrate into the aktivitas quickly and effectively. Each member of the stress berat care team will likely have a different idea of what a stress berat fellow should be and should do; these diverse expectations can complicate the fellow’s grasp of what the job will encompass.
Over the past 25 years, I have worked almost daily and quite closely with over 100 orthopaedic traumatology fellows at 2 different busy level 1 university-based stress berat centers. The majority of these fellows have completed at least 4 years of orthopaedic residency work and a surgical intern year accomplished after 4 years of medical school. My relationship with each one of them has been different and determined by their individual needs, abilities, and attitudes. I have been their faculty member, coach, safety net, friend, enemy, technical adviser, designated driver, job counselor, cheerleader, teacher, research adviser, motivator, drill sergeant, career facilitator, and even a shoulder for some to cry on. After all that and some more, I have concluded that there is no ideal stress berat fellow, but there are key elements and factors that optimize the experience.
I expect each stress berat fellow to have a plan, even if it is a vague one. All of them can easily recite where they have been, but the most successful ones know where they are headed. Some have had previous faculty or other mentors who have helped guide them on their career path, and others just know what they want from their careers. Their plans are rarely similar, but successful fellows are goal oriented and know what they need from the fellowship opportunity.
The daily pace and intensity of a hectic stress berat center can swallow a fellow’s time. The best fellows meet this challenge with sustained energy and seemingly limitless enthusiasm equal to the hard work that they are doing. These fellows are more consistently happy because they recognize the importance of their work, and they thrive on it. These fellows tend to throw themselves into every available situation and become very involved in the day-to-day (and night-to-night!) work that must be done. They evaluate patients aggressively, formulate opinions and treatment plans, and are excited to discuss the whys and why nots of their assessments. Their ardor and intensity commonly spill over into their research endeavors. Most have primitive research skills, but they choose projects that capture their interest, so they usually see these projects through to publication. Enthusiasm and energy are nourished directly from their “love of the game.”
I expect fellows to sharpen their sense of awareness to everything that is going on around them and to learn the art of anticipation. Most fellows enter their fellowship programs as “reactive physicians.” They have been taught to wait for things to happen, or for someone to tell them what to do, they then go do something about it. They wait for their education to come passively. Successful fellows have a heightened awareness of situations and can therefore anticipate potential problems. They become “proactive physicians” and use awareness and anticipation to help them to develop a strategy to guide a situation, rather than be guided by the situation. Their ability to anticipate problems helps their patients avoid complications. These fellows understand that the attention to details is directly linked to their successes.
I do not expect fellows to know a lot about traumatology when they start the program. It is always fun if they do, but it is also fun if they do not. I do expect them, however, to crave knowledge like oxygen. Successful fellows realize early on that they have 1 year to establish a foundation of information that they will build upon forever. If they know the literature, then they can discuss it. They can compare and contrast it with what is happening daily in their clinical scenarios. Knowledge of the literature allows them to ask relevant questions that can clear up misunderstandings and also initiate in depth discussions about that or related topics. In addition, critical evaluation of the literature may lead to research projects to provide additional answers to clinical issues. It is common for fellows to not know the history or background regarding certain current treatment standards. It is during these discussions that the knowledge gaps are often filled in. The best fellows expand their knowledge and skills by seeking periodic feedback on their performance, as it relates to the application of their newfound skills. A sincere and sustained hunger for knowledge, and feedback on its application, is an important element to being a successful fellow.
Traumatology involves spontaneity, and spontaneity demands sacrifice. Patients are injured at inconvenient times. Patients have injuries that demand your special skills at those times. Patients have complications that must be treated. The list of unpredictable and erratic demands is never ending in traumatology. Almost all of the fellows I have worked with have sacrificed certain aspects of themselves for their patient’s well-being. Some have not routinely coming late, leaving early, and doing nothing beyond the baseline activity necessary to get a “certificate of completion.” In my opinion, busy stress berat centers with excellent fellowship programs are like great restaurants with a “Giant Buffet.” The fellows who choose not to sacrifice themselves for the program, the patients, and their colleagues are like customers at the Giant Buffet who only choose to nibble on the red Jello. When you sacrifice yourself as a stress berat fellow, it is not altruism without repayment. In fact it is just the opposite. When you sacrifice for your patients, you experience more, are taught more, learn more, and develop improved judgment. Personal sacrifice enriches the fellowship experience.
Traumatology is difficult, but it is essentially impossible to do well if you do not respect the patients and your colleagues. Each patient warrants a “red carpet” treatment regardless of their injury mechanism, body habitus, use and abuse history, employment status, IQ, or other factors. I expect fellows to focus on patient care and not judging the patients or their situations. We treat patients as we would want our own family members to be treated. I also expect fellows to respect and be a great colleague for the other members of the team. Traumatology involves numerous subspecialists with a variety of skills and abilities. Not every subspecialist who serves a stress berat center by taking on-call duty spends their careers focused on trauma. Every member of the team is a human being, and we treat them accordingly. The attending urologist who is frustrating you because he/she is obviously unfamiliar with a traumatically bisected prostate at 3 AM might just be the world authority on female incontinence, work with him/her, and you both might learn something. And the transportation orderly who delivered your patient to the OR 20 minutes later than promised might have had an emergent higher priority patient to deliver to the Cath Laboratory. Assume he is doing the best he can until you know different. When you get frustrated, stop and remember that everyone on the team has abilities and commonly more than 1 job to do. Collegiality and respect are important components for an effective team, and their value is a current focus in medicine.
Everyone expects the fellow to be honest. Honesty is the foundation for trust, and trust is the foundation for an excellent working relationship. During the year, the fellow will have thousands of interactions with me and the other members of the team. The clinical information and details that we share impact our clinical judgment and therefore the decisions that we make. The fellow often has information about the patient that others do not, and therefore must be accurate and honest when sharing that information or the overall patient management plan could, and likely will, be flawed. I do not expect the fellow to know the answer to every question asked, but I do expect the fellow to say “I do not know,” or “I did not do that” rather than being dishonest about it or shading the truth. These are the moments when conscientiousness, the desire to do things properly and carefully should eliminate dishonesty’s lure. Conscientiousness frequently rescues honesty in “the heat of the battle” while taking care of patients.5 The clinical course of a severely injured patient is usually a very dynamic process, so clear and honest communication about changes and new developments is crucial to organizing and coordinating the best plan. And if you do choose to be dishonest or tell a half-truth (which is a half-lie!), then it will be essentially impossible to recover your reputation. You may be brilliant and hard working and a technical wizard, but if everyone knows you are dishonest—they will work around you rather than with you. The fellowship year is much more difficult if no one believes what you say. If you do not know, just say so or go find out the proper answer.
As the fellowship year and your relationship with the staff begin, your depth of knowledge will be explored and probed so that teaching and experiences can be tailored throughout the year to meet your needs. Each experience builds onto the previous ones, so the learning can grow exponentially. I expect the fellow to remember what is taught, so we can make progress and achieve our educational goals. If you do not understand what was taught, then ask for a better, or another, explanation. The teaching points must be clear and their relevance made known so the learner will not forget what was taught. If the fellow forgets, or did not grasp, what he/she learned several days or weeks earlier, then we have to go back and start all over again. It is much better to be slow and progressive, than to have to backtrack. I expect the fellow to remember (along with me) those patients who were excellent examples of important learning points. By remembering our patients, we can go beyond the obvious aspects and can detail the subtleties of their injuries and treatments. A tip for effective fellowship pembinaan is to keep a log/notebook of your learning experiences, so one can refer back to it when needed.
I expect the fellow to enjoy the work and to have fun. Most orthopaedic stress berat surgeons reflect back on their fellowship year as their favorite educational year because it was fun. The work is hard, the surgeries are complex, the patients are difficult, the tragedies are depressing, and the pace is often hectic. But despite all that, the work is rewarding, the teaching and learning are almost excessive, the subject matter is interesting, therefore, the fun should be immeasurable. When the fellow has fun, it is a great day.
There is no exact formula or recipe for the perfect orthopaedic traumatology fellow. The expectations that I have developed for fellows are simply based on years of experience being immersed almost daily in stressful situations with a large number and wide variety of different fellows, caring about them and their successes, and loving the service that we are privileged to provide each day. If you love what you do, it never feels like work.
- Camp CL, Gregory JK, Lachman N, et al.. Comparative efficacy of group and individual feedback in gross anatomy for promoting medical student professionalism. Anat Sci Educ. 2010;3:64–72.
- Perman JA. Reinforcing the necessary and obvious: doctors should be nice. J Ky Med Assoc. 2008;106:219–222.
- Hurwitz S, Kelly B, Powis D, et al.. The desirable qualities of future doctors–a study of medical student perceptions. Med Teach. 2013;35:e1332–e1339.
- Kiesau CD, Heim KA, Parekh SG. Leadership and business education in orthopaedic residency pembinaan programs. J Surg Orthop Adv. 2011;20:117–121.
- Horn J, Nelson CE, Brannick MT. Integrity, conscientiousness, and honesty. Psychol Rep. 2004;95:27–38.
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