Blog from the Chair: Teach

Fixing an ankle fracture in the Osler-era green-walled operating room, I silently decided that teaching, research and service would be my life’s work. I had already recognized, as a senior resident, how much fun it was to help a junior resident learn performing a surgery as well as I could have done it myself.

The opportunity to serve the underserved also played a role in that epiphany a quarter century ago. The majority of my role models in residency were in academic medicine (although we rotated with a great group of private surgeons, smartly named “the Four East Group”). I saw great surgeons in both worlds, but I always empathized with the underserved. Being as broke as most of my patients, I had no sense of entitlement and realized early that my life’s work should be for them. Money had to be a very small part of it anyway, as there was little to go around in academics in 1990. I found research interesting, and I published, but my greatest interest was helping people who had no other place to go.

What closed the deal for academics was my wife. Trish liked what I was doing a heck of a lot more in academic medicine, and she has never once complained. The lack of money actually strengthened our marriage, as we lived for what we were doing and took very simple, joyful vacations while scrimping every step of the way to pay for our five children’s needs. While financial times in medicine have generally changed for the worse, they are, remarkably, better in academics these days.

But what really keeps us in academics is the knowledge that we professors have the best teachers: our residents. Where I once taught the repair of simple ankle fractures, evidence-based medicine and decades of experience with complex knee surgery gave me something unique to teach. But the energetic modern resident, who absorbs information like a sponge, is a spectacular teacher as well. My residents routinely update me on the minutiae of areas outside of my expertise – anything that can be clicked, downloaded, or searched. They are perpetual fountains of youth.

In January, I operated on a tragically injured 11-year-old in the middle of the night and was ever so grateful that I could help. That evening, I spoke with Erica, a pony-tailed orthopaedic intern wearing salmon-pink running shoes, who told me the child needed to go to the OR immediately (she was right). Later that night, I worked with Judd, a third-year orthopaedic resident, to surgically manage the child’s mangled extremity. I was humbled by his amazing postoperative care, serious approach and persistent bedside manner.

I am grateful for these experiences as a teacher but also for the way things have changed for the better. In the 1980s, a professor was never questioned. I, on the other hand, am excited to learn from my students. I have stayed in academic medicine because of the opportunity to learn: the orthopaedic resident who spends five years in residency is my key teacher.

Breaking down much of the hierarchy in resident-faculty interactions has yielded real benefits. Students are not as anxious about the possibility of being wrong, (which so often gives rise to the need to always be right). Academic departments—the good ones—focus more on the lives of the med students, residents and faculty. We’re a little like television’s Modern Family—a family with a healthy co-dependency.
In many ways, I view my residents as junior faculty and myself as one of the senior residents. Luckily, we are able to compensate faculty and residents better than what I saw 30 years ago. We do it, in part, by caring for all but with a respectful sense of stewardship.

Modern-day, academic medicine has had a comeuppance, especially at UNM. We are family oriented. We are respectful. We teach, publish and serve all. Amazingly, our professors are teachable.

Bob Schenck
P&C
UNM Department of Orthopaedics & Rehabilitation

Blog from the Chair: There is a Google for that!

It is amazing what we can learn.

When I finished residency in 1989, most of the medical world assumed that you had learned everything you needed for a successful career in Orthopaedic Surgery.  It was the ABOS (American Board of Orthopaedic Surgery) that changed how we look at residency, such that our surgical training was just the beginning of our learning.  In order to do this, the ABOS created a time sensitive “board certification” and mandated the Orthopod to “recertify” every ten years to remain “legal.”  I missed a life long certificate by 36 months.  It turned out to be simple, dumb, luck.

But I didn’t think that in 1989, I thought I was unlucky.  Colleagues would be of two camps, either Pre or Post ’86.  Those in my shoes would constantly complain about the unfairness of it all and the ‘old-timers’ would gloat over their dumb luck.  Sitting through Orthopaedic meetings listen to questions about recertification, I would hear frantic complaints of ‘unfairness’ even discussions of ‘big brother’ controlling our ability to practice; comments which made me realize it was time to start preparing and stop complaining (that reminds me, a future blog).  Although I didn’t feel tremendously ‘advantaged,’ I simply planned on recertifying.  I became board certified in 1992 and went on to pass the computerized ‘recert’ exam in 2002 & again last year in 2012.  I also added the sports subspecialty certification (SSC, what used to be described as a CAQ, Certificate of Added Qualification) in 2011.  I found it almost addictive to prepare properly for the recertification examinations and it became a way for me to understand (and acknowledge) the importance of life long learning.

And that brings me to Google.  I have always been a reader.  Compared to available television, books became my only reliable form of quality indoor entertainment.  Growing up on the Western Slope, there were only weak TV signals crossing the mountains.  One example of quality television, say on a Saturday, were pre-recorded greyhound dog races on KREX out of Grand Junction, Colorado.I rarely turned on television.  Luckily, my father had bought a collection of the Classics (50 books from The Odyssey to The Scarlet Letter) from a travelling salesman who was visiting my Dad’s favorite watering hole. I started at one end and read every book.  Even with that start, in the pre-internet age, it was a challenge to find information even if you had two sets of encyclopedias that Dad had purchased along with ‘The Classics.”  Since 1986 and my forced conversion to life long learning, I look to my residents and students for educational advances especially involving the web.

And that brings me to this blog.  I have learned (thanks to Seth McCord and Schenck kids) that when I have a question on anything, I start with Google.  My ceiling fan clicks, I google the question, “How to stop a ceiling fan from clicking?” and after viewing a ‘You Tube’ video, I quickly learn three simple steps for a quiet fan.  90 minutes later (and challenging my thinning rotator cuffs!), all three ceiling fans at the Schenck House are silently rotating (#1 shaft bolt needs to be tightened, #2 blades are warped, #3 blades are out of balance).

In June, I had dinner with faculty and the ESSKA/AOSSM Travelling Fellows and discuss my well-worn technique of information acquisition.  Two days later, my wife, Trish, receives a text from Michelle Treme:  “Tell Bob I fixed the electrical problem at the house with Google”.   I now use it with everything from questions about computers, with any purchase, be it a trip to Carbondale or Cusco, and even for background work for a surgery, lecture, patient problem, or even how to blog.

So thank goodness that we don’t know everything in Orthopaedics, realizing that things change (as in life) and we must continue to learn.  And Google is now my first step, even though I still flip through our worn Britannica’s in Carbondale.  So the next time you are told that you have to follow different rules, like the ABOS re-certification rules in 1986, what we think is bad often turns out to be good luck.  Google it!

Bob Schenck
P&C
UNM Department of Orthopaedics & Rehabilitation

Blog from the Chair: Bring in the New Year!

I have always loved any excuse to celebrate successes.  But one party that I have always questioned is the celebration of New Years in December.  Growing up in rural Colorado, I always loved the winter, but New Years Eve and Day felt no different.  Both were ski days and taxes really aren’t due until April; hence, New Years in my view was simply a different date on the calendar.  But being in academic medicine, I really see a more important date that we definitely need to celebrate as the ‘real’ New Year, and that is June 30^th to July 1^st. Let me explain...

Orthopaedic Residents and Med Students

July 1^st has real meaning for us as the ‘New Year’ and we really need to celebrate:  it is special for everyone.  Graduating residents move to a fellowship or to a ‘real job’ and we welcome our newest group of resident physicians and interns.  The interns are always excited to begin their careers as ‘doctors,’ and current faculty and residents get to welcome the best and brightest whom we worked so hard to recruit.  If you look carefully, the current residents themselves have the opportunity to change a bit.  The 4^th year residents in Orthopaedics now arrive at their final year and can become a ‘chief,’ or ‘senior’ resident, depending upon the institution’s vernacular.  Every resident sees a different experience from the year before, beginning on July 1.  And as I discussed with the Orthopaedic Interns and Residents this past ‘New Year,’ July gives us a great opportunity for self-reflection, that is, a chance to look at our current situations, and make changes, as each person sees fit.

Dr. Schenck with Dr. Keith Gill and Dr. Katherine Gavin

I remember my own transition from General Surgery Intern to Orthopaedic Resident in 1985.  In addition to meeting two important people that year (Wife & Mother-in-law), I critically looked at my interactions with staff, residents, and faculty at Hopkins and decided to make some small changes.  Internship in general surgery in the 80’s was fun but grueling, and I had found that I had become short with people, especially at 3am when I was on call every other night (Hopkins Surgery had an interesting call configuration:  in order to get a weekend off, interns were on call back to back Thursday/Friday or Saturday/Sunday, so ‘every other’ applied only to Monday through Wednesday).  As an attending, I was grateful for the changes made in 2003 with the institution of the 80-hour workweek, and I applaud the additional resident duty hour rules that the ACGME has further refined.  But that being said, in 1985, I looked at “Bob Schenck, PGY-II, and decided that I needed to make some small changes in how I treated people, and work to become more like the person I was in high school, college, and even medical school.  My first step was to start smiling more often, and with some small changes, I saw my ‘intern interactions’ become much more positive.

2013 Crawfish Boil Spread

So I welcome everyone at UNM to focus on this opportunity of ‘bringing in the new’ and make minor changes to improve your own personal situation, be it staff, medical student, mid-level, resident, fellow, or faculty.  It is our New Year’s party, the Annual Orthopaedic Crawfish Boil (it is both New Year’s Eve & Day in my mind) that reminds me to focus on the great lifestyle and what I like to call ‘workstyle’ that academic medicine provides for me and many others who call a health science center their home.  The opportunity to work and learn with medical students, staff, residents, all providers, and faculty is truly what makes academics and UNM, a great place to work.

Residency Program Director - Dr. Gehron Treme and family

So let’s change our calendars for the ‘real’ New Year, and use this opportunity to reflect on where we are, and where we are headed.  And most importantly make subtle little changes to improve our individual personal circumstances.  And everyone should all smile a little more.

Bob Schenck
P&C

UNM Department of Orthopaedics & Rehabilitation

Blog From the Chair: Playing a Bad Lie

I wanted to discuss a recent ‘feel good story’ (Note to reader:  I like telling stories and I have been accused of being “too folksy”). I believe this story has a deeper message for regular people like me and hopefully will have meaning for you. The story involves making mistakes and even possibly living through embarrassing moments.  I don’t want to focus on medical errors in this post, as these ‘mistakes’ are estimated as the 6^th leading cause of death in the US, sadly almost 98,000 per year.  Reducing medical errors is an area of active work at the UNM Hospital involving staff, nurses, residents, and faculty who work tirelessly promoting patient safety and improving outcomes. This post looks more at mistakes or errors outside of the medical world, in our every day personal or professional lives, and how we handle them.  I'm not talking about trying to minimize errors, but there is a great quote from the famed UCLA basketball coach, John Wooden (who I met while covering the Final Four in 1998), who once said, “If you’re not making mistakes, then you’re not doing anything.  I am positive that a doer makes mistakes.”

Orthopaedic surgeons are doers by anyone’s definition, and I have always believed it is what you do with a mistake, a disappointment, or even a bad bounce in life, that teaches and improves your situation.  I have learned from others that when a mistake is made it is very important to quickly acknowledge your role, and if it hurts another, quickly apologize for it, and do everything you can to make it right when possible. {Remember 3 rules of an apology: 1) a sincere apology, 2) ask forgiveness knowing those hurt aren't obligated to forgive, and 3) work to make things right}.  But once you have recognized your part in the mistake, it is important to learn from it.  I believe you should make appropriate changes and most importantly learn to “move on.”  It is healthy to acknowledge your part in a problem and learn from it. But, what I have done, and warn others against, is to continue reminding yourself of your failure or mistake.  You need to pick yourself up, dust yourself off (which involves forgiving yourself, kinda’ folksy eh?), and move on by quickly learning how to smile again.

Dr. Schenck and Son at Bandon Dunes

And this now comes to last week’s British Open (“The Open,” as we say across the pond).  If you didn’t know it, I am a fan of the pro golfer, Phil Mickelson. Although Phil makes his fair share of mistakes, I believe he is popular because he’s a lot like the everyday person.  He makes mistakes, has had some very difficult and embarrassing moments in golf, but ,in my opinion, he keeps things in perspective.  Consider a recent low round at the Scottish Open after which Phil was quoted as saying,  “Some of my greatest rounds started with a bogey,” meaning, Phil messed up at the start of some of his best days playing golf.  Tiger is Tiger and hugely popular, but Phil has his golfing ups and downs, and does his best to bounce back.  He recently won the British Open, a links style of golf that never suited Phil’s golf game.  This was his fifth ‘Major’ and came only one month after losing the US Open in Phildadelphia.  Many of you know this, but for those of you who don’t, Phil Mickelson has come in second place at the US Open a record six times. After the US open at the Marion Country Club there were many critics of Phil, and even more disappointed fans.  But, ever the gentleman, after his US Open loss in June Phil Mickelson stuck around the clubhouse signing autographs for fans and congratulating the winner, Justin Rose.

Dr. Veitch Playing a Bad Lie

In the world of the sports heroes Phil was a breath of fresh air as he went on to win “The Open.”  Think about it, he had just lost another major for the sixth time, but instead of focusing on the loss in June, he picked himself up, started preparing for links type golf, and actually won the Scottish and British Opens.  This was the first time in history both were won by the same person in the same year.  It was commented on by writers that Phil maintained his cool throughout those two wins this past July.  Phil Mickelson made some great shots this past Sunday at the British Open (approaches at 17th, 330 yard fairway wood, and 18th, a pitch to 12 feet birdying both holes), but he had some minor mistakes and some bad luck. It was on the par 3 sixteen at Muirfield where Phil hit a great iron shot to the green only to have it roll off 45 feet where he would have a difficult up and down for par.  Instead of cursing on the 16^th tee box, where ESPN microphones are everywhere, he was heard speaking to his caddie, “Wow, that’s as good as I got.”  The critics will say, “Phil knows he’s on stage so he watches what he says.”  But, in my opinion, that is you and me.  Think about when we walk into the pre-op area where there can be requests or changes to the schedule.  Instead of sulking because we can't find the consent or have to update an H & P, we must act professionally and simply re-consent the patient, or go back into Powerchart and get things ready, keeping the patient’s well being as our first priority.  And it is that attitude in the face of life’s disappointments, where the average Jane & Joe Orthopod must function with professionalism. 

In Orthopaedics we are held in great regard, but unlike the celebrities, it is expected that we maintain our cool during times of adversity, minor or major.  It is this “Phil-like” behavior of maintaining your cool, even if you feel like slamming your club or cursing, that I see on a daily basis in our staff, mid-levels, residents, and faculty.  We handle things with class even during adversity.  In life and medicine, we must learn to quickly pick ourselves up, learn from our mistakes and move on.  And realize that your mistake or loss, when handled properly, can quickly turn into a great success story, just like two recent weekends in Scotland.

Bob Schenck
P&C
UNM Department of Orthopaedics & Rehabilitation

16th Hole Bandon Dunes, Oregon Coast

Blog From the Chair

A blog (a contraction of the words web log)^[1] is a discussion or informational site published on the World Wide Web and consisting of discrete entries ("posts") typically displayed in reverse chronological order (the most recent post appears first).

For my first blog as UNM’s chair, I thought it would be best for everyone (especially me!) to define the concept of a blog or web log.  We at UNM Ortho have so much to be proud of, including the fine group of faculty, residents, and staff who make our department so special.  But most recently, what struck me was a comment made by Urvij (known as “UV,” Ortho Trauma fellow ’12-’13), this past Wednesday, when he stopped by to say goodbye after his year with us at UNM.  Like Urvij’s personality, he had very kind words for UNM and what we stand for.  But what really struck me was one word he used about UNM Ortho, prefaced with the comment that it was something he has not experienced, especially to the level he saw in our program.  He commented that UNM Ortho has such great harmony.  His observation was that of the relationship between residents and faculty being close but with tremendous mutual respect and that we worked in harmony for the patient’s good, making our workplace tremendously positive and in his opinion (and mine) different from any other program he has seen.  I saw it later that evening at the resident’s teaching/lab conference on ACL and meniscal surgery.  The attendance was phenomenal and residents stayed late, learned, laughed, and I was even teased about my very cool 'pac man' socks (I explained I am the demographic for Target).  Twenty four hours later (last night), I stopped by Dale Hoekstra’s pediatric team/social get together he has organized for years after work with Selina Silva and daughter, Sophia, Antony Kallur, Reilly Kuehn, Mischa Hopson, and Heather Woodin (after first going to the emergency room).   So my first blog only states what may not be obvious to others but something which we enjoy daily and that is our harmony at UNM Ortho and that it is fun coming to work everyday (even weekends) in Orthopaedics.

Bob Schenck

P&C
UNM Department of Orthopaedics & Rehabilitation

1.  Blood, Rebecca.  (September 7, 2000).  Weblogs:  A History and Perspective.