Monday, May 17, 2010

After Reading Through Ch. 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?


  1. Nolen would learn from Louden by sitting in on his morning rounds. Louden worked mostly out of the New York hospital, but would make rounds very early at North Shore. Nolen would listen to his assessments and diagnoses. This would be Louden's way of teaching.
    Grove taught using a tough love style. He would pass some cases to Nolen, but would be on his back the whole time. This intense instruction would be helpful as it would give Nolen strong reinforcement on what he needs to learn and improve on. Also, Grove had very good judgement and great tips. However, he would disappear for days at a time and not tell anyone.
    Steele was very fast and practical. Instead of ordering full tests and procedures for his patients, he would order the minimum to ensure they would not have to pay too much. Similarly, some surgeries called for but didn't need sterile clean up equipment. He would forgo these as they were unnecessary.

    Of the three, I think Steele's technique is the most effective. In a private practice, money seems to be a big issue. Therefore, being practical and money conscious can be very important. Steele taught Nolen very valuable lessons on pragmatism which seems like one of the most important attributes to have in a private practice

  2. Loudon taught his residents by working himself and letting them watch and learn. While making his rounds Loudon would let residents follow him, explaining the various diseases and ailments and his comments about them. Yet while he explained his work to the residents he never let them do the job themselves.

    Grove is very technical and teaches his residents by letting them operate but is very meticulous and yells whenever he spots an error. Although he doesn't directly interfere in their work, he scrutinizes their work the entire time and corrects any errors they make through yelling and cursing. But in the end he really does care about the surgeons and wants to teach them to become the best surgeons they can be.

    Steele also lets all the residents do his operations for him. But while Grove is very hurried and uptight, Steele is relaxed and even-tempered. Steele rushes through an operation and does not care about perfecting the details like Grove. He does not use fancy instruments, but does his job well and quickly. He also does not care how exactly the residents are able to tie up a vessel or make an incision, but has faith in them and treats them as equals.

    I think Steele's method is the most effective because Loudon forgoes letting the residents operate or diagnose themselves, a skill necessary in becoming a surgeon. Grove on the other hand cares far too much about tiny details and does not provide a comfortable atmosphere to learn in. Although Steele may be a little too relaxed about details and cleanliness, he allows the students to work themselves while simultaneously teaching them to be efficient and effective.

  3. Loudon's teaching style involves allowing Dr. Nolen to watch him perform the surgeries but not actually take part in the process himself. While Loudon made his rounds he would let Dr. Nolen follow him around and would talk about diseases and their treatments and any other relevant information.

    Grove would let Dr. Nolen actually perform the surgery - however, he would always carefully supervise him and would often yell at him if any mistakes were made. He doesn't actually ever interfere in Dr. Nolen's work, but is incredibly meticulous and detail orientated, and is not happy unless everything is performed perfectly.

    Steele allows Dr. Nolen to perform surgeries as well, but is much more laid back and relaxed than Grove. Steele works much faster and more frugally, only performing procedures and using instruments that are absolutely necessary. Steele is not too bent over specifics of an operation as long as it is done well, and trusts his residents to do a good job.

    Out of these three, I think that Steele has the most effective teaching method. Although he might be seen as a bit too relaxed over such important work, he ultimately does a great job, while imparting his qualities of efficiency and efficacy to his residents. He also makes it clear that he trusts his residents, which allows for a nicer and often more effective learning environment.

  4. Loudon's importance to residents (or at least Dr. Nolen) was letting them shadow him, commenting on the patients he visited to help the residents understand the cases better.

    Grove's style of teaching involved letting the resident doing all the work but interfering frequently to nit-pickingly correct the resident's technique. This tactic resulting in extremely slow and frustrating surgery, but he taught Dr. Nolen an incredible amount of surgical technique. Grove was also absent frequently, giving the interns more responsibility, but also making them victims of criticism from him whatever they did.

    Steele, like Grove, let the residents do all his surgeries but was far more relaxed, both in manner and teaching methods. He was less demanding/precise than Grove. This attitude made surgery far more relaxing. Steele also took care of post-operative care himself, giving the resident less to do but instilling the importance of person to person care. He also taught Dr. Nolen about looking directly at the patient when making a diagnosis rather than the plain facts.

    I think Steele's "style" was the most effective. He gave the residents the hands on experience they needed and gently guided them through so they didn't make any fatal mistakes, but without frustrating them over less important issues. His attitude also made surgery a much more enjoyable process for residents, helping them to stay calm to focus and get the job done.

  5. Loudon's method of teaching his residents is a more watch and learn style. he would let residents follow him and taking note from what he did. Loudon would also comment on the patients he was working with, to help the residents better understand the cases. even if there was not a patient present, Nolen would follow Loundon around conversing on the subject of diseases and treatments.

    Grove, however, would let Nolen perform surgery, while cautiously supervising him. He never interferes with Nolen's work, though he often corrects mistakes in Nolen's work by commenting harshly and yelling at Nolen. This tough teacher-student relationship seems unnecessary, though seems reasonable if one is looking for a flawless surgery.

    Steele also allows Nolen to work on his own, but is much more reasonable about details. In some ways he comes off as too casual to do quality work. However, in comparison to Grove his style seems to work a perfect balance of attention to detail without being too much of a neatfreak or perfectionist. it worried me that he wasn't always sterile and put so much faith in the residents, though it seems to have worked for him because he is quick and efficient.

    I would have to say Steele's method would work best for me because i am someone who prefers a hands-on learning experience, while hearing verbally what to do as well. Loudon is very good at teaching through instruction. While Grove is very good at letting the residents try it themselves. Steele strikes a middle ground where he works fast and very practically himself, and allows his residents to try things at their own pace as he instructs them.

  6. Nolen would follow Loudon around during the morning rounds. He would be able to listen to his comments just like being tutored. Loudon's teaching methods were not direct. Nolen would have to track him down and watch Loudon do his job and that was how he would learn.
    Grove had the opposite approach, he would let Nolen perform the surgery. Also Grove was also absent leaving more for the interns to do. Yet Grove was very critical, he would yell and criticize Nolen when he was doing the surgeries.
    Steele was kind of a nice balance between the two opposites. He let the residents do the surgeries yet he was not as critical. He did not yell of scream, he was very relaxed. Steele's methods were also very fast, he would not get bogged down in the details of the surgery, he just wanted the job to be done well.
    I do not prefer one style. I like that Nolen could observe a real surgeon doing his job by following around Loudon. I also liked how Grove focused on the details, although he did get a little flustered, he was only trying to ensure that Nolen was doing the best possible job. I also like Steele's more relaxed approach. It seems perfect yet he does not focus on the small details and just looks at the surgeries more generally. I think that Nolen had a perfect combination of observation, perfection, and moderation among these surgeons.

  7. Loudon makes his rounds early in the morning. He will allow residents to follow him in the rounds and to learn through observation. This gives Nolen a lot of one-on-one time and Nolen says Loudon was like a possible to tutor so this is one benefit of this way of teaching. The one drawback to this teaching style is that the residents really have to seek out Loudon and so they can make as little or as much as they desire out of the opportunity to follow him in his rounds.

    Grove is a very anxious teacher. He will be constantly yelling at his residents and he likes his residents to be very elegant in their knot-tying and their incisions. He really likes giving the residents a full lesson about surgery and this will sometimes mean the patient is under anesthesia an hour longer than is necessary. I think this devotion to teaching as a good thing. He is absent for the postoperative rounds and this is a major drawback to Grove as a teacher. The residents have to learn by attempting and failing and Grove often gives contradictory advice.

    Steele is more of a realist. He does not obsess over fine details in the way that Grove does. I think this practicality is a good thing for a teacher. Steele's methods of teaching are in complete contrast to those of Grove. He is very calm and relaxed during the process and I think this type of teaching environment is essential. He takes complete care of all of the postoperative care of patients and I think that this is one drawback because then the residents don't get to experience and learn how to handle a patient postoperatively.

    I think the most effective style is that of Steele's because he is very calm and does not contradict himself as Grove does. He is also very realistic in the extent to which he performs each surgery and I think this is very important. I think Loudon is also a great choice for best teaching style because he gives residents the opportunity to have a private tutor of sorts and this one-on-one experience would be really effective in teaching residents.

  8. Loudon's style of teaching involves getting up to do rounds early in the morning and allowing Dr. Nolen to watch and listen in on his comments as he saw his patients. However, he does much of his surgery at a different hospital in New York, so his teaching style is limited to this discussion during rounds.

    Grove's style of teaching involves incredibly slow and frustrating operations. He spends so much time teaching in the O.R. that the patient is under anesthesia for much longer than necessary. He has a great ability to perform (and teach/allow others to perform) operations, but I believe that he should not teach at the expense of the patient's safety. In addition, he is often absent three days at a time in order to visit his ailing mother. This excessive absence severely limits the quality of his post-operative care and often results in negligence and easily preventable complications (for example, when Dr. Nolen took the drain out too early).

    I think the most effecting teaching method of the three is that of Steele. Steele's style of teaching involves practical, relaxed, scheduled, early, very fast operations. Sometimes Steele's realism has detrimental effects, such as when he fails to practice "good sterile technique" (173) or "(leaves) a stone in the duct" (174), but I think these mistakes are accounted for by his ability to pull patients through in high-risk, precarious situations. Also, the faith he demonstrates towards his residents is inspiring and a great way to teach them. Also, in contrast to Grove, Steele prefers to manage the post-operative care for himself. In this sense, he doesn't neglect them and offers his experience nd judgement; as a result, his patients rarely have problems in the post-op period. Many of his patients' (and his own) troubles are averted.

  9. Loudon's style of teaching would allow Dr. Nolen to simply watch him during surgery but he is not actually allowed to take part in the procedure. While making his rounds, Dr. Nolen was permitted to follow him and talk about the patients' diseases and treatments and other information related to the patient.

    With Grove, Dr. Nolen was allowed to perform the surgery however he was always under careful supervision, and Grove might yell at him if he ever made any mistakes. He never interfered with Dr. Nolen's work but he was very precise and made sure that Dr. Nolen performed his work perfectly.

    Steele also allowed Dr. Nolen to perform surgeries however he was much more laid back than Grove. He is less detail oriented and he does not get obsessed over the little things. Although Steele and Grove are a contrast to Loudon, they are contrasted themselves. It is a good thing that Steele is calm and tranquil during his teaching process. However Steele is the surgeon who takes care of the patients post-operation, which is one bad thing in his teaching style because as a doctor, one must be able to deal with post-operation patients.

    Of the three doctors, I think Steele's method of teaching is the most effective because he allows for little mistakes, which is a good thing because in surgery and being a surgeon/doctor there will be little mistakes that won't make a very big change. In Grove's method of teaching there is no room for mistake, even if they are allowed to perform surgeries. And with Loudon, all Dr. Nolen is doing is observing, which is not the way to become a surgeon/doctor because one needs to practice things to become a good and skilled surgeon.

  10. Loudon tended to show his students what was being done, rather than instructing them just exactly what was happening. Dr. Nolen was able to see what was going on directly, thus allowing his residents to learn via observation.

    Grove, on the other hand, taught while directly performing an operation, in a manner that was much more stressful to the people around him. He is, however, completely devoted to his profession and expects nothing less than the best from his residents.

    Steele's technique provides some sort of intermediary. He allows his residents to perform operations on their own, but he is not half as nitpicky as Loudon. This makes his technique probably the best, because this way, the residents would be able to practice on their own and learn that way all the while not having the stress of being under Grove's scrutiny.

  11. This is Connor Townsend.

    Loudon had the "watch and learn" approach. He let Nolen watch him do his surgeries and other duties during his morning rounds, but never let Nolen actually do anything himself. Nolen would get alot of one on one time with Loudon, so he was kinda like a tutor.

    Grove was like Loudon's polar opposite. Loudon wouldn't let Nolen do nearly anything, Grove insisted that Nolen do pretty much everything. Loudon was calm and cool, while Grove was really strict and yelled alot. He doesn't leave alot of room for error.

    Steele was like a mix of Loudon and Grove. He let Nolen do work himself, but he was calm and respectful the whole time. He's also pretty efficient and not nearly as meticulous as Grove.

    I'd have to say that Loudon had the best style. The problem with Grove is that yelling at inexperienced students and being really rough on them while they're trying to perform a surgery seems like a pretty good way to make them screw up from the pressure. And even though Steele was calm as his kids worked, he wasn't nearly as careful as the others, and it seems like being incredibly meticulous is necessary for a surgeon. Loudon taught alot to his students just by letting them watch. He didn't let fairly inexperienced guys like Nolen go straight into actual surgery.

  12. Loudon's style of teaching is very example-based; he performs his rounds and has the interns only look at what he is doing while he performs the actual operation. This means that Loudon can be extremely informative, but does not often allow his interns to actively participate, which can be integral to the learning process.

    Grove's method is almost the exact opposite. He has a propensity for meticulous detail and harshly critiques the interns. He does let them perform most of the surgeries and is often absent for post-operative care, which can prove to have negative results. His patients often end up under anesthesia longer than they should be because of his need to teach the interns, and while this does help them learn, it can be dangerous for the patient as it increases the amount of chemicals in their body.

    Steele's tactic is somewhat of a middle ground. He lets the residents perform his surgeries but is much calmer about the process and occasionally skimps on what he views to be extraneous details, such as sterile equipment and certain details in the procedure.He does give sufficent instruction and helps them significantly.

    Though I prefer Steele's style of teaching over the other two, I think it is important that Nolen experience instruction under all three of them. Grove's strict instruction teaches Nolen details that Steele might have left out of not explicitly stated. Loudon might have helped Nolen remember things visually and through example, when a first time hands-on experience could have been a danger to the patient Steele teaches him the balance between being an effective and a good surgeon and approaching the task with a rational and practical mindset.

  13. Dr. Loudon teaches by letting residents watch him perform surgeries. Loudon would also let residents shadow him while he makes his rounds and would talk with them about diseases and treatments but he never let residents do any surgeries themselves.

    Dr. Grove had the complete opposite approach. Grove lets the residents perform surgeries and while he doesn’t interfere with their work, he is very critical and he often yelled at Nolen.

    Dr. Steele’s style also involves letting residents do operations but he is much more patient and relaxed. He isn’t very demanding, doesn’t care much for fine details, and works quickly.

    Of the three teaching “styles” I think Steele’s is the most effective. He allows residents to get hands-on experience without overwhelming them with minor details. His calm, relaxed manner is helpful in creating a good learning environment for the residents.

  14. Loudon taught the residents by having them follow him around and watch him work. They watched him during surgery without taking an active part in his procedures. This provides students good example, but does not allow them to be fully engaged in the surgery.
    In contrast, Grove takes a more hands-on approach. He allows the residents to perform surgery, while critiquing them and giving them lots of feedback. Grove would be much more stressful because he often places complete responsibility in the hands of the interns (as he's sometimes not even present).
    Steele also allowed Nolen to do surgery. However, he took a more laid back approach: he remains very calm and trusting of his students. He also pays less attention to details than Grove.
    I think Steele's style was the most effective. His hands-on approach helps prepare the interns for their real jobs in the future. While Loudon's lectures were informative, there's nothing like being able to try a job yourself. Also, his more laid-back attitude creative a less stressful environment, which, in my opinion, is more conducive to learning.

  15. Dr. Loudon’s method of teaching surgical techniques to residents is simple: he performs the operations himself, and has the residents watch carefully and learn from his example while he explains what the problem is and how he is attempting to fix it. This type of instruction is very important, particularly near the outset of surgical training, but is obviously not complete without a hands-on element involved. Dr. Grove, on the other hand, insists that Dr. Nolen do nearly all the mechanical procedures himself, demanding perfection and often getting caught up in small details. Although this approach is much more stressful for the resident, I think Dr. Grove is completely right in emphasizing attention to detail—the learning period is when a surgeon’s habits start to form, and it’s much easier to form a good habit than to try to correct a bad habit later. Dr. Steele also lets the residents perform surgery themselves, but instructs in a much more laid-back fashion and allows minor errors to go unchecked. This style gives the resident the most feelings of responsibility and respect, and would likely be preferred by most.

    However, I think that Dr. Grove’s methodology is the most affective. While Dr. Steele’s easygoing, practical instruction would be preferable later on when overseeing a more experienced surgeon, while a resident is in training it’s important to cement proper surgical techniques; a minor detail in one case could be important in a different case, and the surgeon should know how to handle it. But ideally, to ease the stress of working under Dr. Grove, the resident would start their training under Dr. Loudon or another observation-based instructor.

  16. Loudon taught his residents by letting them follow him around while he was working. By doing this, they would see what he did with his patients, and they would learn to follow what he did. In this system, the residents would only be able to benefit from this system if they found Loudon and actively tried to follow what he was teaching.

    Grove takes a much more strict approach to teaching his students, letting them perform surgery and deal with patients, while criticizing them whenever they did something wrong. He is very careful about precision, and whenever his residents make a mistake, he lets them know and tells them what they are doing wrong.

    Steele lets the residents perform surgery and deal with patients like Grove, but he is not as harsh on his residents and is more relaxed about surgery more like Loudon. I think that Steele finds a good balance between Loudon and Grove's style of teaching that is very functional and effective, but at the same time he does not have to constantly criticize them and put pressure on them. I think Steele's style of teaching is the best, because the residents are able to perform surgery and gain experience, while there is not pressured too much.

  17. Although Grove is not an incredibly likable character, I personally believe that his style of teaching is better than those of Drs. Loudon or Steele.

    Golf and playing the Clarinet are two skills that I have spent a lot of time practicing, and I think that I am improving at both. While practicing my golf swing or playing the clarinet "too quickly" doesn't endanger lives, it can have some bad ramifications. To develop the fine motor skills necessary for being a clarinetist or a golfer (and the gross motor skills also associated with a golf swing), It is important to practice the motions over and over again, and the key is to practice slowly. Certainly when I am playing a concert, it is necessary to wiggle my fingers as fast as the conductor wants me to, but most teachers say that to really learn your part, you should practice at half speed. When you go too quickly, you may accidentally miss a note one time - not a problem - but little issues like these are a slippery slope. Habits are developed very easily, and if you don't slow down to fix a problem right away, you will probably keep messing up. In golf, similarly, the most common thing I hear my coach say is, "Slow Down, Ben, Slow Down!" The faster you go, the less control you have over your body. Mistakes are more easily overlooked, and especially in a golf swing, one minor issue can easily start a chain reaction that can have a really negative (yet subtle) impact on the mechanics of the swing. Slow practice is key.

    I imagine that surgery is similar. Steele's quick and dirty methods leave room for things to be overlooked. Down the road, Dr. Nolan might never remember something that he could have learned from one of Dr. Steele's patients. In the fast paced nature of the surgery, something, I'm sure, could be overlooked. I think that Dr. Grove's approach of slow, meticulous practice will make sure that Nolen's tequnique is very good. Once this is solid, it will be much safer to speed up because he'll deeply understand every aspect of what he is doing.

    Additionally, there is limited amount one can learn by watching Tiger Woods swing, or listening to Benny Goodman play. It is important to observe professionals, but the best learning always seems to occur in the practice room or at the driving range. Dr. Loudon was probably a very good teacher, but by not allowing Nolen to have a lot of actual operating time, he most likely was not doing Nolen a favor.

    Now that I have thoroughly exhausted this metaphor, I'm done.

  18. Loudon's teaching style consists of him doing all of the surgical work, while his residents would carefully watch, but not do any actual operating. He would lecture them on various techniques and diseases, but never did he allow the residents to participate in any work.
    Grove's teaching style is very different than that of Loudon, since he would let his residents do operating work. Nevertheless, he was extremely cautious and would immediately correct or remove the residents from operating if they were doing something wrong. When he corrects them, he kind of yells at them and at times curses, but at least he gives them the chance to do the actual work. Grove is very tense and nervous, and he makes his residents nervous.
    Steele, similarly to Grove, allows the residents to do operating work. Unlike Grove however, he is more relaxed and doesn't really ever yell at them. He has full faith in his residents, and does everything in his power to keep them relaxed and comfortable.
    All three teaching styles have their positive tactics, however, I believe that Loudon's style is slightly more effective. I understand how Steele's would be the most favored one, and I appreciate his relaxed and trusting spirit, but in a field as particular as surgery, where there is no room for mistakes, little mess-ups, although not life-threatening, should not be taken lightly. It is important to fully understand how to perform surgery before actually performing surgery on a living being. I think Loudon gave residents the best medical background, and thoroughly prepared them for a successful first surgery. My ideal style, however, would be one where residents could perform surgeries with a very careful doctor who will relaxingly correct them if they make mistakes.

  19. (alex k, period 3)

    The attending surgeons (Loudon, Grove, and Steele) have very different approaches to training residents. Louden's teaching style is characterized by lecturing and demonstrating. His comments to patients and residents have value for residents because it gives them an accurate example to follow. Though residents observe operations done correctly, they have very few opportunities to gain hands-on experience under Louden's tutelage.

    Grove is an effective teacher in other ways. He clearly has passion and enthusiasm for teaching, which provides the residents with a solid foundation of knowledge. He also allows the residents to do some of the operations. However, residents don't usually get far in their attempts because of Grove's strict attention to detail. This attention to detail and borderline perfectionism makes Dr. Grove seem somewhat highly strung.

    Steele's teaching style is a stark contrast to Grove's. Steele is much more imprecise and relaxed in his style of operating and teaching. He allows his residents to be much less meticulous in their frequent opportunities to practice operations.

    I think each attending is a useful teacher for a resident. Each one has a unique contribution to a resident's experience and knowledge that is most useful at a given point in a residency. At the very beginning of a residency, Louden's or Grove's teaching styles are probably the most useful. Louden's would have limited benefit because residents need hands-on practice to become effective doctors, but the basic understanding of procedures would be a useful foundation for practice operating. Grove's style is probably the most helpful one for the majority of residents. Though Grove's attitude seems to make Nolen a bit nervous at times, it ensures safe practice. Hopefully Grove's high standards for the residents would instill some attention to detail in residents that would make them better doctors in the future. Steele's technique would be best suited to more seasoned residents who already have a solid understanding of basic procedures and just want more practice with various surgeries.

  20. Loudon's style of teaching is to have Nolen follow him while he makes his rounds. He doesn't let Nolen do any work of his own. He simply lectures and makes comments on the patients. This meaning that Nolen does not get to physically participate.

    Grove lets Nolen operate, however he criticizes Nolen's every move. He is super tough to please and insults Nolen's work often for not being precise or clean enough. He also disappears for long amounts of time, in which Nolen performs no operations. He works slowly and meticulously.

    Steele lets residents do all his cases. When he teaches students, he praises them for doing good work. He is messy and practices unsterile techniques on patients, yet is a fast worker.

    I think I prefer Grove's method of teaching because his strictness will prevent Nolen from making messy mistakes and will teach Nolen to be as meticulous as he himself is. However, Grove's slowness is not a good thing to have when patients are dying. And he also is usually not there to help his patients recover. But, I think those bad traits do not affect his great teaching skills.

    I think that Nolen needs all three teachers and their different teaching methods in order for him to have the best learning experience.

  21. Nolen would sit in on Dr. Louden's morning rounds, so he would not have the opportunity to get much hands-on practice. Dr. Louden also worked at the NY hospital most of the time.

    Grove has a very tough manner. I think he shows Nolen some tough love all in the name of getting the job done correctly. Grove is very meticulous and pent up on specifics. He teaches Nolen how to be on top of his game in a somewhat stressful way. It's good that Nolen has the opportunity to get hands-on training though.
    Steele also allows his residents to perform surgeries. He has a very calm, even-tempered manner. He is very practical and is not too concerned about specifics like Dr. Grove. Steele does what's neccesary to get the job done; no fancy techniques required.

    I think that Steele has the best teaching style because he allows Nolen to operate in a somewhat tranquil enviroment. Grove creates a room full of stress even though he gets the job done. Steele's practicality is also a good quality for Nolen to obtain. I do think that it's good to have some of Grove's guidance because he teaches the residents how to operate under lots of pressure.

  22. Nolen learns a lot from all three attending surgeons, however in their own individual styles. Loudon is more 'watch and learn', with a heavy emphasis on listening in on morning rounds, lectures and observation.Loudon is the only one who does not let Nolen participate in a hands on manner. Grove is a stickler for detail, harshly criticizing Nolen whenever a tiny mistake/ imperfection is made, however he does let Nolen participate in surgery. Grove is extremely tough, slow, and frustrating for Nolen to work with. Steele seems to be the ideal of all three, as he moves quickly and efficiently is over all just more "chill." It seems that from a patient's point of view, Grove's technique seems to be the safest/ I would trust Grove to perform surgery on me, but from a resident's point of view, I would prefer Steele, because he's overall less tedious and difficult.

  23. Loudon allows Nolen and the other residents to shadow him on his rounds, and to watch while he performs operations. He frequently tells the residents useful tidbits of information regarding diseases and treatments. However, Loudon does not allow the residents to perform the surgeries themselves.

    Grove, on the other hand, does let Nolen perform surgeries--but he keeps a very close watch on the young resident throughout the entire procedure! Grove's behavior during surgery is quite uptight--he yells at the residents when they make even the slightest errors, because he is very meticulous about his work.

    Steele, like Grove, allows Nolen and the other residents to perform surgeries. Steele and Grove and polar opposites in terms of their operating personalities--while Grove is a perfectionist and very brash in voicing his opinions, Steele is much more laid-back, and not as careful about doing absolutely perfect work. Steele demonstrates to the residents that he has faith in their ability as surgeons, and this is comforting to Dr. Nolen.

    I think that all of their teaching strategies have merit--Loudon's is very informative, and if the residents are paying attention while they follow him on his rounds, they will learn a great deal. His denial to let them perform surgeries is a hindrance to the learning process, but on the other hand, it is beneficial to the safety of the patient undergoing surgery! (After all, who wants to be operated on by an inexperienced resident?) Grove's commitment to a job well done is admirable, and his passion for his work is clearly imparted to the residents. However, his constant screaming would make for a very stressful experience in the operating room! Steele's calming influence is hugely helpful for nervous residents, and his comforting reassurance aids the new surgeons to do their best.

  24. Louden would allow Dr.Nolen to observe the surgeries and procedures and would explain to him how everything worked without actually letting Dr. Nolen get his hands dirty and try things himself. Louden's teaching style is thus more through observation than through hands-on experiences.

    Grove's methods are perhaps more harsh than the others. He allows the residents to be hands-on and do surgeries themselves; however, he scolds them for the slightest error and yells a lot because he wants to make sure that everything is done perfectly.

    Steele, like Grove, allows the residents to perform surgeries themselves. However, Steele is much more relaxed and allows the residents to sort of figure out things for themselves. Steele treats the residents more like his equals than someone he was teaching, and in that sense gives his residents confidence in their work.

    I think that there is something to be said for all three methods. However, if I had to chose one that I thought was the most effective in terms of teaching the residents to be good doctors, I would go with Steele's methods. While as a patient I might not necessarily feel comfortable with Steele's methods because he is not super meticulous, I think that as a mentor his methods are the best because he allows the residents to learn on their own while still being supervised. Also, his more relaxed attitude would make the residents more comfortable and less nervous about being in the operating room.

  25. Loudon's teaching revolves around allowing Nolen conceptually understand cases. However, he does not does not allow Nolen to do any hands on work. This can be helpful in that Nolen gets a firmer grasp on cases without the expense of hurting anyone via malpractice.

    Grove is a cut-throat, strict teacher who will berate Nolen's every move. Unlike Loudon, Grove lets Nolen work on his patients, so that Nolen can get a hands-on experience and more of a feel for the surgery environment and procedures. Grove's surgery skill is slow, and very nit-picky, in that everything must be perfect. While Grove's approach is very careful and meticulous, Grove is very slow in his surgeries. Grove focuses more on technique.

    Steele is a calm and very fast surgeon who also lets Nolen work on his patients. However, Steele zooms out and instead of Grove being caught in each individual tree, Steele looks at the entire forest and evaluates each case from that viewpoint. Essentially, Steele does not get bogged down in little details, but works on general terms of just saving the patient.

    I think Steele's method of teaching is the most effective one. What Nolen needs to learn as a surgeon is for him to be able to evaluate each case and effectively get the job done. Once he is past the first hurdle, he can then work on perfecting his technique. I think that Steele's teaching allows Nolen to get the best experience because he allows Nolen to work on this patients in a relatively low stress environment. Although being meticulous in technique is important, it is not the biggest factor in surgery. Steele doesn't have fantastic technique but he still get the job done, showing that being meticulous isn't the most important thing in the surgery room. All in all, the combination of these three teachers is what makes a great surgeon. Loudon creates the foundation of knowledge for Nolen, Steele creates the general mold for Nolen, and Grove does the final polishing.

  26. In this part, Nolen writes about Loudon, Grove, and Steele, the surgeons most willing to instruct residents on the practice. Loudon's style is the least hands-on of the three, for Nolen never indicates that he performed a surgery under his guidance, but since Nolen was able to follow him around closely most mornings he did learn a lot about the practice from observation. Grove, who did regularly allow residents to perform operations, also taught Nolen a great deal, though usually in the sense that he nitpicked at every detail, found fault with every tiny mistake, and searched out every false move. Though Grove himself had forgotten certain surgical techniques and was sometimes a bit of a flake himself (as when he would dissapear for 3 days at a time), he was an effective surgeon, always managed to clean up a case even if he made a mistake during the first operation, and was a great technical teacher, even if his bluntness and crudeness made him "too great" of one. Steele also took a hands on approach to instruction, though he was considerably less impatient than Grove. He was comparatively relaxed and calm, and he never lost his temper or nitpicked about trivial matters. Also, he was revered for his efficiency and quickness, and for his good handling of the post-operative procedures. Apparently he was not known as the most meticulous of the three, but he had as great a success rate as Grove.

    I would say that, while Steele's method is a good balance of encouragement, bluntness, and practical preparation, Grove's approach might be most useful for a surgeon. For medicine does not require abolute accuracy to succeed, but those who strive to be the most accurate they can have the greatest chance of success, and I think that, while Grove's personality is a bit hard to take, his candidness and no-nonsense nature serve well as traits for a surgeon.

  27. Grove seems to be rather disparaging during the surgery itself, but somewhat encouraging after the procedures. He criticizes all of Dr. Nolen's actions but it is a tough love approach, because he winds up acknowledging Nolen's potential by saying that it was "not too bad." He allows the younger residents to have full control of the surgery (he did not step in during Nolen's gall surgery) but also provides good instruction, albeit rudely stated, that protects the patients. The residents get surgical experience without compromising the health and safety of the patient. Grove is very careful and pays attention to detail, whereas Steele is "as fast as Grove was slow, as gross as Grove was meticulous."

    Steele is primarily portrayed as the quick, deft surgeon who is even-tempered with his residents. He is practical, as shown for his disregard for sterile technique before a hemorrhoidectomy, which produces waste in the wound. He also does tries to get the job done as efficiently as possible, without much flourish. Grove was more pessimistic about the patient's chances of living, but Steele projected confidence. He also has more faith in his residents than the other doctors, and believes that "the patient would do as well with him assisting the resident as if he wielded the scalpel himself." He let Nolen proceed with a major operation on Mr. Cappa without any reservations, but rather gently guided him throughout the surgery. He has an intuitive sense for diagnostics that follows his fast-paced methodology.

    Loudon is principaled and follows a tight schedule. He seems to be content simply allowing the residents to shadow him to glean experience. While I think that Grove has a pretty decent approach and his teaching methods seem to align with those that Nolen experienced at Bellevue, I would say that Steele has the better method because he encourages his residents. The pressure that Grove puts on his residents may be detrimental because it may cause them to crumble in high-stress situations. Steele is more nurturing and positive, which gives his residents a proper amount of confidence.

  28. Loudon lets Dr. Nolen watch him do surgeries. However, Dr. Nolen does not actually practice doing them himself. Dr. Nolen followed Loudon when he went to see his patients. Loudon taught him about the different illnesses the patients had and what type of treatments was using. In contrast, Grove allowed Dr. Nolen to perform surgeries. At the same time, he did not always keep track of exactly how Dr. Nolen was doing and sometimes he would scold him after he had already made mistakes. He wants everything to be done perfectly but he doesn’t have enough time to make sure that Dr. Nolen is doing everything well all the time. Steele has a much more relaxed attitude than Grove. He lets Dr. Nolen perform surgeries, but he is much faster when he works. Steele gives his residents a lot more power over what they do than the other doctors do. It seems to me like Steele had the best method for teaching. He let the doctors perform surgeries, and allowed them to learn without interfering much.

  29. Grove has a tough-love approach; but, while sometimes a little harsh and/or rude, he allows the residents to perform major surgeries and gives them accurate and meticulous instruction that allows them to learn and keeps the patient safe.
    Steele is certainly nicer than Grove. However, he lacks Grove's meticulousness - rather, he favors speed, and is extremely bare-bones practical in his approach to surgery. He demonstrates many times that he has immense faith in all his residents to do well, allowing them to step in for him to perform surgeries.
    Loudon has a watch-and-learn type approach, allowing the residents to shadow him and look over his surgeries as he operates. However, Loudon never lets the residents try anything for themselves. Watching can only teach a person so much. This style works well for those who learn best from observation; however, I believe his teaching style is the less effective for to be a really good surgeon you must have technically perfect physical skills.
    I would say that either Grove or Steele has the most effective teaching style. I guess it just depends on the type of learner the resident is: for a tough-love approach that favors meticulous attention to detail, you have Grove, and for a practical, gentler approach to surgery that skims over the tiny things, you have Steele.

  30. Loudon seems to primarily focus on the scholarly aspect of being a surgeon. Nolen seems to do no surgeries under him, but Nolen primarily learns from Loudon by following him around and taking note of his actions. It is a good way to avoid the mistakes of residents,however, it robs the residents of the opportunity to further improve their hands on skill set.
    Grove on the other hand allows his residents to perform surgery however he is so nit-picky and detail oriented he often says castigating statements that causes the residents to be all too wary and pressured. This type of environment can lead to indecisive surgeons who can not come through in a clutch situation. On the other hand his focused style teaches the residents the gravity of their actions and also teaches them the importance of trying to get as many details right as possible to allow surgery to pass as snoothely as possible.
    Steele is very different from grove because he is mch more relaxed and encouraging. Residents under him gets hands on experience but it feels almost too casual and unserious. It is important to be calm in high stressed surgery situations but Steele almost seems to foster carelessness that can eventually lead to disaster.
    I think that good balance of grove and loudon would be best. Loudons expertice in teaching outside the surgery setting would help many residents. As in groves case the hands on is important but a slight toning down of his over bearing watchful eye would allow the residents to bloom with precise skill with wariness of the gravity while maintaining and obtaining confidence.

  31. Loudon teaches his students mainly by lecture and demonstration. He allows Nolen to observe surgeries and expects him to learn simply by watching the operations, and listening to the occasional comment concerning the patient. Although Loudon serves as an accurate example to learn procedures from, Nolen is not permitted to perform any kind of surgery.

    Groves does allow Nolen to gain hands-on experience from working on patients. However, during the surgery, Groves will remain very uptight and strict about every single little detail. Groves gets upset and yells at Nolen with every mistake, but the instruction that he gives during the surgery is both meticulous and accurate.

    Steele also presents Nolen with the opportunity to perform on real patients. However, Steele is less detail-oriented, and instead strives for speed and efficiency. His methods are more practical to expedite the ultimate goal of saving a patient's life, as opposed to Groves' focus on the precision of the actual procedure.

    Although all three methods have the potential to be successful, I think that Steele's didactic approach is the most effective. He allows for Nolen to gather hands-on experience, while still being encouraging and helpful in advising. Essentially, Nolen is left to learn on his own through surgeries that he is performing, while still being under a professional supervision.

  32. Loudon's style of teaching includes having the residents primarily watch surgeries. He doesnt let them actually do the surgery and instead just lectures them about it and lets them watch. It helps Dr. Nolen learn about important surgeries though it isnt very practical because he never is able to practice actually doing the surgery.

    Grove takes a different approach and lets Dr. Nolen perform surgeries himself though he keeps a very close watch on him and makes sure he is doing everything correctly. He doesnt like to intervene however, and instead chooses to yell at Dr. Nolen when he does something wrong. He is always very tense and uptight but he knows what he is doing and is able to explain thoroughly to Dr. Nolen what he is supposed to do.

    Steele also allows Dr. Nolen to perform surgeries though he is more laid back about it. Steele trusts the residents more and therefore allows them more freedom with the surgeries. He lets them do what they think is right and isnt constantly worrying about what they are perhaps doing wrong. He doesnt treat the residents as inferior to himself which gives them confidence in their work.

    I think that Steeles approach is the most successful even though it is risky. It seems as though because Steele is so laid back, he wont catch the mistakes the residents are making though because he is laid back the residents are as well which makes it possible for them to be more focused on the surgery rather on whether or not they are doing something wrong. Without the supervisor constantly watching over them they are able to learn better technique through focused and low-stress practice.