Besides technical and surgical proficiency, some of the most important skills for a young Neurotologist to refine include communication and critical thinking abilities. This Early Practice article provides perspectives on common challenges and career development from a current Neurotology fellow and his mentor.
Key points
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Tumors of the ear and temporal bone present numerous treatment challenges for all surgeons, particularly those in the early stages of their careers.
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Although the trainee will tend to focus on learning technical and surgical details, some of the most important skills for a young neurotologist to refine include communication and critical thinking abilities.
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Critical analysis of the literature and one’s own results will lead to continuous improvement and a rewarding career.
Introduction
As a distinct medical and surgical specialty, neurotology is still young. The work of pioneering individuals in the mid-20th century laid the groundwork for the modern treatment of temporal bone and cerebellopontine angle tumors. Despite the relatively short history of neurotology, management strategies for these tumors have evolved significantly because of recent technological advances, refinements in surgical techniques, and growing knowledge of the natural history of lateral skull base diseases.
Young surgeons in their final years of residency and fellowship, as well as those just beginning in independent practice, face the formidable challenge of accumulating the necessary knowledge for comprehensive management of skull base tumors. Even at high-volume academic medical centers, trainees may only encounter a handful of examples of some of the diseases neurotologists are called upon to treat. With a relatively small volume of personal experience to draw from, an ever-growing body of literature, increasingly high expectations from patients and payers, and an inherently challenging set of diseases to treat, young neurotologists may find themselves overwhelmed in early stages of their career.
This Early Practice article, a feature new to the Clinics , is intended to be a collection of insights and observations that residents, fellows, and recent graduates might find useful as they transition into practice. The details of tumor-specific patient management will be left to those colleagues who are contributing to this 2-part series. Instead, perspectives will be provided by a current neurotology fellow (JTB) and his mentor (JTV) in a discussion about the everyday challenges faced by practicing lateral skull base surgeons. Out of decades of experience, the mentor has identified 6 key skills and qualities a successful neurotologist must exhibit. These items will be examined from the perspective of a surgeon just beginning his or her career as well as that of a seasoned veteran.
Introduction
As a distinct medical and surgical specialty, neurotology is still young. The work of pioneering individuals in the mid-20th century laid the groundwork for the modern treatment of temporal bone and cerebellopontine angle tumors. Despite the relatively short history of neurotology, management strategies for these tumors have evolved significantly because of recent technological advances, refinements in surgical techniques, and growing knowledge of the natural history of lateral skull base diseases.
Young surgeons in their final years of residency and fellowship, as well as those just beginning in independent practice, face the formidable challenge of accumulating the necessary knowledge for comprehensive management of skull base tumors. Even at high-volume academic medical centers, trainees may only encounter a handful of examples of some of the diseases neurotologists are called upon to treat. With a relatively small volume of personal experience to draw from, an ever-growing body of literature, increasingly high expectations from patients and payers, and an inherently challenging set of diseases to treat, young neurotologists may find themselves overwhelmed in early stages of their career.
This Early Practice article, a feature new to the Clinics , is intended to be a collection of insights and observations that residents, fellows, and recent graduates might find useful as they transition into practice. The details of tumor-specific patient management will be left to those colleagues who are contributing to this 2-part series. Instead, perspectives will be provided by a current neurotology fellow (JTB) and his mentor (JTV) in a discussion about the everyday challenges faced by practicing lateral skull base surgeons. Out of decades of experience, the mentor has identified 6 key skills and qualities a successful neurotologist must exhibit. These items will be examined from the perspective of a surgeon just beginning his or her career as well as that of a seasoned veteran.
Responsibility
Breen
As surgeons and physicians, we are privileged to care for our patients. For neurotologists, this privilege is coupled to the expectation that we are ready to provide the highest level of care for patients with challenging problems. Medicine has become a profession far too complex for any practitioner to be expected to have comprehensive knowledge of all disease. When deciding to become a subspecialist, however, the trainee has committed himself or herself to an intense course of study in his or her chosen field.
Opinions on optimal treatment may vary, particularly with the relatively rare diseases treated by neurotologists, but appropriate decisions simply cannot be made without a comprehensive fund of knowledge. There is no substitute for reading the relevant literature, studying in the temporal bone laboratory, and participating in the care of patients treated by our mentors. Particularly in an era of increasing trainee numbers, decreasing surgical case numbers, and duty hour restrictions, every patient encounter is one that demands the full attention of the trainee to maximize the learning experience. The lucky few who have the opportunity to train with masters in this field have a responsibility to become experts. This cannot happen if a strong foundation is not laid by many hours of hard work during the training years.
Vrabec
It is difficult for the trainee to fully understand the burden of responsibility that comes with independent practice, because there is always a faculty member serving as the final decision maker. However, this lesson is rapidly learned. No matter how broad an experience a trainee receives, one can never see everything. There are usually a few moments in the first few months of practice where a novel clinical problem or operative situation arises, and the new practitioner must respond. When the newly acquired knowledge and skills are challenged, the graduate understands the assumption of responsibility that comes with independent practice.
Even after decades of practice, clinical challenges continue to arise. This intellectual stimulation is one of the most rewarding aspects of the profession. It is unlikely that one will ever become bored with clinical or operative care. Responding to novel situations requires a broad perspective on the range of possible actions, anticipation of potential outcomes, consideration of comparable problems, and assigning probabilities of success to each available choice. The ultimate decision may be questioned by patients or colleagues. The ability to discuss the decision making logically and accurately and respond to criticism is the definition of the responsible physician.
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