The Halstedian residency was developed to provide graduated levels of resident learning and responsibility. From within this model arose the paradigm of “see one, do one, teach one”; a simple phrase for a not-so-simple task. The maxim strictly translates to learning a procedure by seeing it done once, then performing it, and finally, teaching it to others. In reality, the ability to advance so rapidly in learning a skill is near impossible, and likely dangerous.
As healthcare has changed since Halstead’s introduction of the residency program, so has the structure of surgical education. The traditional model of surgical training has been affected by work-hour restrictions, stricter oversight regulations and importantly, a critical appraisal of patient care and outcomes.1 The classic adage can therefore be adapted to fall more in line with today’s healthcare goals, as described by Dr. Rod Rohrich, in which one should strive to:
“see many [and] learn from the outcome, do many with supervision and learn from the outcome, and teach many with supervision and learn from the outcome”.2
In this revised model, emphasis is placed on learning through repetition under the guidance of experts, while constantly scrutinizing one’s outcomes to optimize results and patient safety. This becomes an intimidating task as the compendium of different procedures in the field of Plastic Surgery is staggeringly broad and dauntingly complex. However, breaking down each component of the cycle into practical points helps provide direction to develop the appropriate habits to learn efficiently and safely.
“Seeing one”, or observing in a case, can be prone to a detrimental cycle of loss of focus, perceived lack of interest, and absence of teaching. This cycle can be broken, however, by better understanding the value of observing others and what is needed to utilize these opportunities for self-development. Most critical is preparation. Preparing for a case as if you are the one performing it promotes familiarity with the basic steps of an operation. This foundation will inevitably make the case more interesting and also allow one to better assist the operating surgeon. In addition, this level of preparation provides the opportunity to glean more advanced information rather than just trying to keep up.
Retention of information learned from observing a case is also important for progress. Taking a few notes after seeing something new is a quick and easy method of forced review. There are several free note-taking apps such as Evernote® and OneNoteTM (Microsoft, Seattle, WA) that can efficiently organize and sync notes across different mobile and computer-based platforms. Along with this comes the importance of seeing not just “one”, but “many”.2 Repetition is key for familiarity, comprehension and mastery. Furthermore, critically observing many surgeons perform the same procedure provides the opportunity to witness variations in techniques. Combined with an analysis of results among different patients and surgeons, this habit allows one to formulate operative plans on outcomes-based data and choose the optimal techniques for completing each aspect of a procedure.
When it comes to “doing one”, preparation inherently becomes even more crucial. Multi-volume textbooks have long been the gold standard for learning and remain an important resource for foundational knowledge. Several other sources offer high-yield information including the Plastic & Reconstructive Surgery journal “Resident Reader Collection”, Continuing Medical Education (CME) articles, the Plastic Surgery Educational Network (PSEN) “Resident Education Center”, and the American Orthopaedic Surgery Reference application, among many others.3 The availability of high quality procedural videos, however, has revolutionized case preparation. The Also, Plastic & Reconstructive Surgery journal “Video Collection” and the American Society for Aesthetic Plastic Surgery RADAR Resource are invaluable libraries of countless in-depth instructional videos that are imperative to watch prior to cases.