August 1, 2021

Part 3 - Observing doesn't mean seeing

Written by Matija Krkovic

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Experienced glider pilots know exactly where to find a thermal, which will allow them to climb up in the air, and stay there longer. Needless to say, they are always very happy to explain to a newbie, or anyone actually, what to look for and where. There are no secrets. 

But the clouds keep changing. Initially, I thought that clouds are pretty much always the same shape but that they travel around. Maybe that sometimes they changed their size depending on their water content. You will have to imagine my surprise when I learned that this was not the case and that it could actually not be any further from the truth. Clouds are actually dynamic! They decay as they grow. 

Clouds grow because of the thermals: warm air rises until it reaches the dew point and a cloud is born. And this is happening all the time. As one cloud dies, another forms. 

Now, imagine me, a complete newbie at this, observing the clouds and trying to determine where the lift is. 

Is observing the same as seeing? 

When you take your trainee through a procedure they have never done before in their life, how much should you expect them to retain? Probably some parts of the procedure; definitely not all of the relevant parts on which you have been building for years. Is this surprising? Not really. 

It’s like re-watching a movie: you will pick up much more information the second time. But we rarely re-watch a movie. To a trainee, a new procedure is far more valuable in the knowledge and information it brings than a movie. In my understanding, low retention rate directly correlates to the amount of ‘new’ information coming your way. The more new stuff you tell them, the less they are likely to retain. The more new information you tell them, the less they will retain, for they have nothing to relate it to. Something similar happens when a patient is explained the procedure during the consenting process.

These days I try to organise my list to have at least similar procedures on the same day, if possible. I have learnt that doing it this way helps to improve the trainee’s performance and self-confidence. Or, at least that’s what has transpired from their feedback. But, it’s not always possible and then, a delay of a few days is much better than repeating it a month later. However, such a plan does not actually improve their observational skills. Instead, what it does is increase the proportion of time they spend in ‘autopilot’ mode and focus on intricate details and think about what they are doing and why. By this time they have already forgotten the tips and tricks you showed them previously and unless you show them again, they will not be able to pick it up. And even then, do not expect them to retain everything. 

At this stage, your part is probably over and your trainee should be able to complete a procedure to a satisfactory standard/level. They will, however, very likely still not be able to execute those certain tips and tricks that make the procedure easier and more successful. The question is: do they have to be YOUR tips and tricks? Not necessarily. In my opinion, someone’s technique should be an amalgamation of different techniques adjusted for their skills.

From what just said it seems reasonable to me to create a training process which will include as high retention rate as possible for the training. What I am proposing to my current trainee is that he spends approximately 6 months operating under my supervision. In this time he will get enough experience to improve his observational skills and retention. Then for 2-3 months he stops operating and only observes and learns subtle tricks from different surgeons if possible and for the last 3-4 months of his training he is back operating on his own with supervision if necessary, ideally without. At this stage I expect him to become a master in the next 10 years.

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