Everybody Sucks at the Beginning

In September, during my first three weeks of surgical rotation, I had a challenging time which was ultimately a growth experience. I felt quite despondent thinking I was incompetent with my surgical skills, especially with suturing and cutting surgical knots the right length, without taking too long and annoying my preceptor. I found this especially frustrating since in my prior rotation with anesthesiology, I seemed to have a “knack” at getting intravenous access and getting endotracheal tubes in. My anesthesia preceptor said I had good hand-eye coordination and a future in anesthesia which made me quite elated as it is now a burgeoning area of interest for me (little did I know at the time that I just had a nice case of beginner’s luck but I am still working quite hard at developing my skills in anesthesia).

One of my favorite aspects of the Integrated Community Clerkship program at UBC, is the close relationship you develop with your family medicine preceptor. I had a debriefing with him about my surgery rotation and he recommended that I join him for some of his small procedures on Wednesday mornings before he started his clinic.

I distinctly remember going to the first procedure with my family preceptor where we were doing an excisional biopsy of a basal cell carcinoma.   I was expecting just to do the suturing after he excised the lesion, but then he handed me the scalpel. I was so nervous, but with his instruction and guidance, the procedure was completed successfully albeit taking much longer than it would have taken my preceptor. However, it was an exhilarating feeling to complete a procedure that would positively impact this individual.

There were two key aspects that really helped me excel during this simple procedure compared to during my surgical rotation. One was that I spent a considerable amount of time practicing in low stakes environment. I practiced suturing banana skins to master this skill because it is much too difficult to learn the basic mechanics with the pressure of doing it on a real person. This was the major mistake I was making during my surgical rotation. Secondly, I needed to drastically reduce my expectations. My surgical preceptors made suturing seem so easy, and it made me feel bad that I was struggling so much with it.

However, my preceptor said something to me that has really resonated with me and has become my defacto mantra during my third-year clerkship, “Everybody sucks at the beginning.” It is so spot on! As a high-level athlete in the past and a sports fanatic, the defining feature of a great athlete is making the difficult seem easy, and that is exactly what an excellent surgeon does. They were not magically born with masterful suturing skills. It took years of intense diligent effort to master.

I learned it’s paramount to not lose hope, keep pushing forward, practicing, and being nice to yourself. It is going to take much longer, and you will not be close to the competency of your preceptors for a while. However, slowly your skills will develop. The following week I was doing another procedure and it was remarkable how much more confident and competent I felt after just doing one procedure the week before. I am starting to see this as a reoccurring theme for medical school, with respect to many different skills. I keep doing at it and then, finally, something clicks and I get it. The way I conceptualize it, coming from a systems perspective, is that you just need enough negative feedback to develop a refined enough sense to execute these complicated tasks with enough proficiency to accomplish your particular goal, whether that is gaining intravenous access, visualizing the optic disc, or closing a wound with an excellent cosmetic result. Just remember, if you feel you are terrible at some procedural skill initially, you are in great company because everybody sucks at the beginning.