TRYING WORK Teaching surgical residents can be challenging to say the least.

I'm blessed to educate the next generation of surgeons. Teaching, however, requires supreme patience, especially when you're dealing with these residents:

• The Know-It-All. This resident believes he's on Chapter 9, but he's still floundering in the preamble of the book of surgical knowledge. Some of these bombastic few earn the title professor since they exude a sense of supreme confidence and erudition. They continually cite needless trivia in a hopeless attempt to convince others (and themselves) that they really do know orthopedics. Yes, they may know the innervation of the articularis genu, but have no idea what a rotator cuff is. Time for a huge slice of humble pie.
• All Thumbs. These unfortunate few likely entered a surgical career to please a parent or for mere egoic gratification. Too many episodes of "Grey's Anatomy" are perhaps to blame. Manual dexterity is not their strong suit; they probably suffer at home when asked to carve the turkey. Some are so challenged with motor skills that if I walk they can't chew gum. What many of these souls lack in dexterity they make up in intelligence and perseverance. Yes, they usually can draw out the brachial plexus, but tying their shoelaces can prove to be an ordeal. Thankfully, we are in the age of simulation; many residents have seen meteoric gains in their skills.
• Rambo. This resident possesses reasonably good manual dexterity, but has all the gentleness and kindness to tissue of an MMA fighter. Arthroscopy is truly not his gig; he's much more comfortable wielding a saw or Magnum drill. When supervising Rambo, the Hail Mary's are flowing and I dread the occurrence of collateral damage. These residents need a crash course in ballet or tai chi in order to accrue the skill of fluidity in motion. In time most do learn that truly great surgeons are kind to tissues.

• Guilty as Charged. These poor souls are extremely conscientious, but leave themselves little margin for error. One errant portal placement crescendos into a freefall of self-reproach and self-castigation. These promising young adults have an advanced degree in guilt and need to recognize that 'to err is human.' After several minutes of head hanging, I remind them that we have 5 more cases to do!
• The Timid. This resident is well qualified and has excelled in pretty much every endeavor he has embraced — except assertiveness training. The timid brand is afraid to ask to do more surgery and is quick to relinquish the case at the onset of difficulty. There is a fine line between humility and poor self-esteem, and this lot tends to suffer from deep feelings of inadequacy. My approach is to validate them and remind them that they are not grade-A steamed cow dung. Rather, they are gifted young men and women blessed with the opportunity to heal others.
• Glacial Speed. The obsessive-compulsive-disorder-riddled resident has nuked all semblance of spontaneity in their stress-riddled lives. Every movement is calculated with exact precision. Left to their own designs, these tormented souls may spend hours determining the perfect incision. These beleaguered spirits seem to have great difficulty getting out of first gear and require much on-site coaching. When the tourniquet time exceeds an hour and the second scope portal has not been established, I gently nudge this breed into action and remind them that I don't wish to keep a diary of every case.