Sunday, August 31, 2014

The joy of suturing

sutures in hand
Beautiful, simple sutures.
Last week we posted on what it takes to become an expert and just how much time experts put into developing skills (read the full post here). Coincidentally, Dr Ilana Mendels – so much a fan of veterinary continuing education that she became an official provider of it through VetPrac – emailed about an upcoming suture workshop.

Suturing? Isn’t that a basic skill and shouldn’t all vets be highly skilled at it? Well, yes and no. We learned those skills back at uni under guidance of specialists, then went out into the world and did our best. We practiced and practice, but as I learned last week pure practice doesn’t equal perfection.



Practice needs to be purposeful.

And then, when we DO become skilled, the action follows as second nature. We develop expert induced amnesia. When that happens, it can be hard to recognise problems and break bad habits.

As the ever-enthusiastic Dr Mendels says,

When we use our skills every day, we rarely remember action for action, how we came to develop the skill. We usually remember a frustration in learning, the awe towards our mentors and peers and then, through fumbling and practice over time - it one day clicks. 

So spending a day focusing on suturing, now that one has the benefit of experience under one’s belt, could be quite enlightening.
The suture is the central locus for a surgeon. It is the known thing, around which all the other things we know about surgery become significant and depend of each other.  The suturing workshop will be fun. We'll be doing some basic ties, and some fancy ones. We'll show you some specialist tips and share stories of "man vs tissue".

We will also go over some important points to remember about types of suture and needles, which is a funny thing that most of us ignore... If you're anything like ANY of the vets I've worked with you'll be familiar with "absorbable 3-0" as the regular request. But if you consider your skill as a craft, then the type of needles and materials become increasingly more important. And we will discuss this, because good surgeons, like good artists, know their materials as well as their canvas. 



There is a tendency for people to think they have learned one thing, ticked it off and can now move on. On the contrary. When its a skill you use every day, there's always something new, always something you can improve. (Of course, its always a little challenging when you do the best sutures in the universe and your patient goes home for "bed rest", gets a touch of ye olde cabin fever and jumps over the fence to hang out with next door's poodle...or lets their housemate nibble the sutures out prematurely). 

But seriously, I love the teaching philosophy behind this workshop, the palpable enthusiasm and the concept that we can always work harder at mastering (or tweaking) the so-called simple things we take for granted. It makes me wonder what other skills veterinarians and nurses use that are second nature, and whether we could benefit from revisiting some of those.

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