Lifelong learning is important

Medicine is unique as a profession in that it combines art and science. Physicians are trained in humanities as well as sciences. This background begins as early as high school and continues throughout college and medical school. This is helpful as new physicians learn to relate and take a careful history from patients of different ages, backgrounds, and cultures. It is also critical in formulating the treatment plan. Each patient has unique life stories and situations that require a customized plan for them. At the same time, data gathering and care planning need to be done using carefully controlled studies and evidence-based medicine to guide treatments. One needs to feel comfortable with the sciences to interpret new studies as they are reported. Physicians create better therapeutic plans as they become established and available.

I have practiced orthopedic surgery my entire career in the community of Elkins. I founded Tygart Valley Orthopedics on Aug. 15, 1996. During my practice I am often asked, “How long does it take to become an orthopedic surgeon?” and “How long is the training?” The correct answer is learning should never end. The science of medicine has rapidly evolved before and during my 22 years of practice. I do few surgeries the same way I was trained in my orthopedic residency. If one wishes to become an orthopedic surgeon, they need to take “pre-med” classes during their undergraduate college curriculum. This includes courses in chemistry, biology, math, physics, as well as a mix of the liberal arts. Most pre-med students fear their year of organic chemistry as a major barrier to earning acceptance to medical school. One then attends medical school to begin study of the medical sciences. This typically consists of a very intense classroom schedule for 2 years where we learn anatomy, physiology, pharmacology, and pathology. Although there are many other courses, these four form the core of medical knowledge in all specialties. The third and fourth years are devoted to clinical studies. Typically third year medical students follow a fixed schedule, introducing them to the various main branches of medicine, including Internal Medicine, General Surgery, Pediatrics, Psychiatry, Obstetrics, and many other subspecialties. The fourth and final year allows students to explore their future interests and try out for training programs. In my case, I focused on orthopedic rotations and studied related topics like radiology, rehab, and trauma. During fourth year, students apply for internship and residency positions. The application process for training can be extremely competitive. One of the most stressful but exciting days of a student’s life is “match day”. This is the day they find out their future, learning where their residency will occur and in what area of specialty. Intern year teaches new surgeons how to care for patients, especially in the hospital setting. One learns emergency medicine and general surgery skills. Once orthopedic training begins, which typically lasts 5-7 years, the trainee becomes more of an apprentice journeyman. They evolve from an assistant who daily learns on the job to a skilled independent practitioner. By the completion of their chief resident year, they should be ready to start a career.

My chairman at the University of Virginia, Gwo-Jaw Wang, told me many times during my residency that learning would begin the day I left training and started practice. As usual, he was right. In my 22 years of practice, I have attended many continuing medical education courses. I am a member of specialty societies, including the American Academy of Orthopedic Surgeons, the WV Orthopedics Society, the McCue Society, the Arthroscopy Association of North America, and the Hip and Knee Society. They publish journals reporting the latest discoveries and trends in orthopedic medicine within their area of expertise. I have attended cadaver courses to learn new surgical techniques as technology has evolved. An example is arthroscopic rotator cuff repair. When I was training at the University of Virginia, we made a 4-inch incision, split the muscle, and repaired the rotator cuff. This was very painful and usually required 1-2 nights of hospitalization. In the last 15 years, I have adopted new technology to perform all shoulder repairs arthroscopically. This means the surgery is done much as building a ship in a bottle. We work through three to four 0.25-inch incisions.

Another opportunity for learning is teaching. Our Hippocratic Oath requires us to teach the next generation of medical personnel. In the Elkins area, I have had the pleasure of teaching medical students as well as physician assistant students, nursing students, and athletic training students. This is a great way to stay fresh. It is amazing the insightful questions that students ask that keep the professor on his toes.

I consider myself blessed to have chosen a career as rewarding as orthopedic surgery. My job is fixing people. Every day I see patients that I have helped return to better function and less pain in their daily lives. To maintain my skills at a cutting-edge level, it is necessary for me to continue learning on a daily basis. What better way is there to keep the mind healthy and young?

Further, this is both necessary and professionally rewarding. I have taught my children since they could walk and talk that they should learn something new every single day. Practicing orthopedic surgery helps me to practice what I preach and keep life interesting.

— Richard Topping, MD, is the founding partner and President of Tygart Valley Orthopedics in Elkins.