Thursday, May 20, 2010

After Reading Chapters 13, 14 & 15

At the private hospital on Long Island, the attending surgeons Loudon, Grove and Steele each had different “styles” of teaching young residents the art of surgical technique. What “style” did each have? Whose style do you think was most effective? Why?

Post your response by Tuesday, May 25th.


  1. Well, there really was not much about Dr. Loudon. However, Jim did mention that watching and listening to Loudon do his rounds was like "having the chief of surgery as a private tutor." That does sound nice and very helpful, but Dr. Nolen did not much elaborate on this. However, he did talk extensively about his experiences with doctors Steele and Grove.
    Both Steele and Grove let the residents do all their cases, which is extremely beneficial to the residents. Steele, however, is very relaxed and not at all meticulous. He seems to be mainly concerned about the resident's learning the gist of what is going on. Even when he is scheduled to operate on the father of a North Shore doctor, he lets Dr. Nolen do the surgery, while providing only loose but informative guidance. His method does seem effective, however I feel that the experience that Dr. Nolen gains when operating with Steele is no different from the experience Dr. Nolen gains when he operates on anyone. There seems to be nothing unique about Dr. Nolen's experiences with Steele. Dr. Nolen is gaining extremely valuable experience, but nothing particularly special.
    On the other hand, I feel that Dr. Nolen's experiences with Dr. Grove provide key insights into the art of surgical technique. Grove, as described by Nolen, is extremely meticulous and slow, and ridiculously picky about everything. However, this fastidiousness seems to really benefit Dr. Nolen, as Nolen says himself that he "learned more technique from [Grove] than from anyone [Nolen] ever encountered." Although Grove seems obnoxiously fussy at first, in the end it seems to directly benefit Dr. Nolen. So, although all three doctors are great surgeons, it seems to me that Dr. Nolen benefited the most from the detailed teachings of Dr. Grove, rather than from the simple experience-giving practices of Dr. Steele.

  2. All three of these surgeons were the "most interested in teaching and training residents, and who had the self-confidence to know that they didn't have to wield the scalpel themselves to assure their patients a good operation". Apparently, all three surgeons had large practices and could get positive results.
    Dr. Louden's style of teaching is definitely not covered in these chapters, as Brett noted. Dr. Louden always performed in the mornings, but he seemed like the God of North Shore Hospital the way Dr. Nolen described him. Dr. Grove's style to me was the most unique because he was so meticulous in the way he performed surgeries, but was also the most strict as well. He dealt with the residents in the harshest way possible during the operations always criticizing their works. On the other hand, Dr. Steele is the complete opposite of Dr. Grove: loose, outgoing, and very carefree. Steele was a realist.
    I personally think that Dr. Steele's method of teaching a resident during surgery is the best possible option because time in the operating room is everything. According to Nolen, Steele always saw each patient twice everyday, was always even-tempered and never swore. On the other hand, Grove never took care of his patients post-operation, which is the most important part of a patient's health. Steele is the ideal surgeon that I would mold other surgeons around because of his ability to realistically see the operation for what it really is, while saving the patient in a quicker time, and being the best post-operative doctor. Furthermore, his confidence in what he was doing and his belief in a resident can really be a moral booster. I think that Dr. Nolen benefitted more from learning from Steele rather than Grove.

  3. During his stay at the long island hospital Nolen studies under three doctors, Louden, Grove, and Steele. Each brings their own skill and prowess to the job and Nolen learns something different from each doctor.

    Of the three doctors, Louden seems to be the one who Nolen really looks up to. Although he only dedicates a couple of lines to his studies under Louden, Nolen respects Louden more than many of the doctors at bellvue.

    When Nolen studies under Steele he realizes that a doctor who is sloppy and disorganized can be successful. Steele gives Nolen the kind of freedom that a teenager would die for. He lets Nolen conduct his own surgeries and uses a hands off approach to teach his students.

    Not surprisingly, Nolen learns the most under Dr. Grove. Grove has principles that are completely different from Steele's. He keeps track of everything and watches his residents with the utmost care. Although stressful, he ensures that Nolen learns to do thing the right way the first time. Grove's style is most effective because he teaches his surgeons not to make mistakes, but to save lives. If lives weren't on the line Steele's approach of letting the doctors figure things out themselves might have been the better tactic. But because real people suffer from the residents' mistakes, Grove's style is necessary to prevent problems.

  4. Well, like Brett said, there wasn't too much about Jeff Loudon in the book. It seems that most of what Nolen learned from him came from following him around during his rounds in the early morning. He seems very precise and punctual, and is apparently the "chief of surgery."

    Nolen described his first operation with Dr. Grove as "hell from start to finish." While he does let the resident or intern do the procedure, he constantly corrects and harasses them, in both amusing and and not so amusing ways. While, perhaps harassment isn't the best technique for instruction, Grove's methods do get the point across in a manner that is unforgettably clear. Nolen also says that, "When he said, 'Not too bad, Nolen - I'll make a surgeon out of you yet,' my resentment melted away."

    Steele lets residents do all of his surgeries. Nolen describes him as a realist, with a more hands off and relaxed demeanor. He's also cocky and a bit reckless, which transfers into his teaching technique.

    As far as a preference, I think Grove is probably the better teacher. He is meticulous in technique and procedure, even if he is abusive and annoying. I feel that he would make a more productive and informative role model for an aspiring surgeon.

  5. Dr. Loudon is given barely a page of text in TMOAS, but the main impression that Nolen gives of the doctor is that he was a very punctual man with a tight schedule. I feel like Loudon doesn't really teach Nolen hands-on, but rather has Nolen watch as he talks to his various patients and does his surgeries. Nolen is allocated more of an assistant role with Loudon, rather than a get-your-hands-dirty method of teaching.

    Dr. Grove is, I think, the most effective teacher out of the "big three" at North Shore. His, slow, meticulous surgeries coupled with his high standards for Dr. Nolen make for very good teaching tools for a budding young surgeon. The fact that Grove lets Nolen do many of the surgeries alongside him is a very close and personal way to teach. However, Grove's short temper and expectance that everything be done right the first time are extremely beneficial to Nolen's surgical accuracy and maturity. Also, the fact that Grove carries out surgeries slowly and meticulously allows Nolen to observe the "proper" way to do it, and gives Nolen more decision room whether he wants to be as slow and careful as possible with his own patients.

    Steele, on the other hand, reminds me very much of Dr. House. The doctor seems to have a "sixth sense" for diagnosing patients and is lightning fast in surgery, but is sloppy in both practice and appearance. Though Steele allows Nolen more freedom than the other two doctors, Nolen gets taught unorthodox surgery for the sake of saving time and as a consequence loses some appreciation for proper procedure. I feel that Steele is fine by himself as a surgeon, but is not a very good teacher or role model to student surgeons like Nolen.

  6. Dr. Loulan works in a style most beneficial to his patients, and least be beneficial to his interns. His works almost independently, and uses his expertise to achieve good results. He is a very successful surgeon, but people do not learn from his knowledge. I would rather have him as my doctor than any of the others, yet I would not enjoy being a resident in his hospital.

    Dr. Grove, in contrast to Loulan, lets Nolan work hands on. He achieves good results but puts the patient in some risk when he lets Nolan do the surgeries. He is a very effective teacher but not all that of an effective surgeon. I would rather have him as a teacher but not as much as a surgeon.

    Dr. Steele is the worst surgeon of the three. He is lackluster and disorganized. He would be neither a good teacher nor a good surgeon. He has a fantastic mind, but he does not put it to good use.

  7. Karli said...

    Out of the three surgeons, I'd have to say that Steele was the most effective. Loudon wasn't described much, and Grove was very erratic and unreliable. However, he was very good at getting interns to think for themselves and diagnose stuff through experience and thought, as proven by the rubber drain case, when the author was chastised for pulling the drain out too soon- even though he had been chastised earlier for not pulling it out soon enough. In other words, the author was forced to learn to look for clues that would reveal certain tips about what to do next. However, Steele's efficiancy, though a bit brash at times, truly showed Nolen how to become a good surgeon: orderly, efficient, and practiced. His refusal to use fancy equipment if it isn't necessary helped Nolan realize that it isn't the equipment that's important- it's the surgeon. Through these tactics and his ability to diagnose anything anytime and quickly, Nolan was able to pick up some tips.

  8. Though we didn’t learn much about Dr. Loudon, we do get a sense that Dr. Nolen found him to be helpful, and following him to be enlightening. It sounds as though his time with Dr. Loudon was beneficial but we were not told enough to know how he was helpful.

    Dr. Steele was very lackadaisical and in many ways could have been seen as someone who didn’t take his job seriously. He was a perfect example of somebody who new what they were doing but didn’t show it. He was a realist and let residents do all of his surgeries. He gave Dr. Nolen much needed surgery time, but was not the most helpful person to work with.

    Dr. Grove on the other hand was very precise, and gave Dr. Nolen the opportunity to see a different technique where surgery was concerned. He is the most effective of the surgeons I believe because he pays very careful attention not to slip up. He teaches this to Dr. Nolen and I feel as though this is one of the most valuable lessons one can learn. I feel as though it is very important to emphasize how important it is to do all that you can not to make mistakes. This is no longer medical school, mistakes can cost lives and Dr. Grove seems to understand this. Because he is a successful surgeon and he still pays careful attention not to make mistakes means that he doesn’t take his experience level for granted. I think Dr. Grove was the most successful of the teachers, and I would want someone like him…even though he yells… :)

  9. As many have said before, we don't get too much of a sense of Dr. Loudon's learning style, so I won't say much except that I agree with Taro's statement that he is, in effect, the God of North Shore.

    We do learn quite a bit more about Steele and Grove however. Both are at the same level as Loudon skillwise, we learn, but we see much more of their specific actions than with Loudon. Steele is less precise, and seems to believe that experience is the best teacher. He is perceived by many as the less diligent of the two, a reasonably accurate assessment, though it should be noted that the results of his care is not notably lesser than those of Grove, as he is mentioned on the same level, as one of the three most confident and competent doctors.
    Like Steele, Grove allows others to operate; unlike Steele, he's a lot more nitpicky, and a lot more focused on the technique.
    The main difference between these two doctors can really be summed up in a couple words. Results vs. Methods. Steele seems to care a lot more about results, showing Dr. Nolen unorthodox surgical practice that still has good results, and allowing surgeons more time to get the feel of surgery (something I have noted in previous comments to be essential). On the other hand, Grove is much more about method, forcing Dr. Nolen to concentrate on proper technique and procedure.
    I seriously doubt that it could really be said that any of these three doctors were "bad" teachers; in fact I believe that a surgeon would be lucky to have any of the three as his teacher. Both of the teaching styles we examined more closely are effective; proper method and procedure is needed, but so, sometimes, is unorthodox practices that produce results with less time or less complex equipment (especially in a place like Bellevue, where complex equipment is not always available.)

  10. Sasha said...

    Standard; Dr. Nolen never really says much about Dr. Louden. He seems to have been very competent, and Nolen speaks well of him, but he never really did anything that made a huge impression on Nolen. The difference between the other two doctors, Dr. Grove and Dr. Steele, reminds me of the difference between French and English teachers at EB. Dr Steele is like a typical English teacher: obviously smart and talented, but laid back. He is disorganized in appearance and in the way he practices medicine. He aims to save time and is more about the bigger picture than about proper procedure.
    Being fastidious and detail-oriented aren't his priorities: his guidance is more relaxed, which, to some, is a better teaching method because coddling makes for a better learning atmosphere, but I tend to disagree with that. (That isn't to say, however, that there is no benefit to a supportive learning environment; I just think that it is a rare teacher that can command respect without keeping their students on their toes.)
    Dr. Grove is more the equivalent of the classic French teacher: fastidious and precise (to quote Queen), as well as disciplined in dress and in surgery. He is also prone to yelling. Dr. Grove harasses his residents, and if you gave him a mustache and some chalk to throw, he may actually have worked at EB. He is tough on his students and has a pretty biting sense of humor, and once Nolen acclimates to this, he learns not to take it at face value and even to appreciate it. Grove is the best teacher because he instills respect, not only for himself, but for the surgical process: when lives are on the line, every detail counts.

  11. The book does not give a lot of information of Dr. Loudon, only that he is a capable surgeon and a good surgeon (as Brett mentioned, Dr. Nolen says that listening to Loudon take notes on his patients' conditions was "like having the chief of surgery as a private tutor." (p. 169)
    Dr. Grove's style, for some reason, reminds me most of the type of people that Dr. Nolen met at Bellevue. His unabashed, hard hitting critique on all the minute mistakes Dr. Nolen made and his willingness to allow residents to actually operate on some cases is similar to the styles of the head doctors at Bellevue, not including George Walters from Chapter 2 who remained patient and only butted in when it was clear Nolen was screwing up. Grove, on the other hand, would immediately start yelling and raving at Nolen for things like holding a scalpel the wrong way, taking care to insult his technique for added effect. I guess it is Grove's harshness and haste that most reminded me of Bellevue.
    Grove's style contrasts most obviously with that of Steele, the most calm and collected of the three doctors. Always emitting an essence of sangfroid, he never swears or runs in the hospital, unlike Grove. However, this mellow attitude seems to vanish as soon as he steps foot in the operating room, where he becomes the hastiest of the three doctors. Dr. Nolen says that "Steele was a realist", meaning that he didn't bother to take the time for what he saw as unnecessary procedures. His style in the operating room proves, once again, to be the polar opposite of Grove's, who is very meticulous and prefers to take his time with each and every step of an operation.

    I believe that Dr. Grove's style is the most effective. Not only that, but Dr. Nolen himself admits that though he "questioned [Grove's] judgement... [Dr. Nolen] learned more technique from him than anyone [he] ever encountered." (p. 171) It would appear that being tough on one's "students" is the most effective way to get them to learn, which supports the argument that many people made in the first blog entry that working at Bellevue and under worse conditions is actually more conducive to learning.

  12. As almost everyone has mentioned, the book did not really give much about Dr. Loudon except that he worked in the mornings and Nolen learned a lot from him. I think that his style was much less hands-on and Loudon was focusing more on getting everything done in his busy schedule than taking extra time to teach.

    Grove is very meticulous and slow and expects everything to be done perfectly the first time around. He teaches people to not make mistakes and his harsh teaching style really seemed to help Nolen learn how to become a better surgeon.

    Steele is very relaxed and sloppier than Grove and Loudon. He is very hands off and lets the residents do the surgeries on their own. He is described like a realist and I would agree with Matt’s comparison to Dr. House.

    I think that Grove’s style was most effective. He scared the residents into learning never to make mistakes and to take the time and get the job done right the first time around. Although I would never want such a frightening teacher, his hands-on approach and meticulous manner really seemed to be a very effective teaching style.