Learning is a complex process that does not take the same path for every individual. Many components play a role in how well one learns, how much knowledge is retained, and how efficiently and confidently that knowledge is used. Veterinary medicine is a complex and difficult subject. The amount of information and skills required to become an excellent clinician take time and practice to develop. Progression of these skills often involves significant risk of failure, error, and inefficiency.
When it comes to veterinary medicine, and surgery specifically, confidence is built over time. Early experiences with surgery can drastically affect future performance. In order to trust in one’s skills and ability to make appropriate decisions regarding cases, an understanding must exist regarding how to appropriately create a surgical plan, how to follow through with that plan, and how to deal with problems as they arise. Failures can radically change a veterinarian’s willingness to approach new challenges, and this self-doubt can worsen a fear of errors and even lead to imposter syndrome.
Many veterinarians have significant apprehension toward and may even dread surgical cases because experience has seemed to show them they are not as qualified as they feel they should be to take on these often complex cases. Whether due to imposter syndrome, a demanding clinical schedule, or previous failures, these veterinary surgeons are in need of a supportive environment to increase their confidence, skill set, decision-making ability, and positive mindset.
Read more below to explore a few of the reasons many veterinarians lack surgical confidence and how the right learning tools and environment, as can be found in the new Small Animal Soft Tissue Surgery Certificate, can boost surgical assurance, improve decision-making, and battle against imposter syndrome to create a truly confident veterinary surgeon.
Surgical Confidence and Skills - It Takes Time
Surgery is an area of medicine where very few excel automatically, as it takes development of a specific set of skills that is very different from other proficiencies one acquires as a veterinarian. It is also a discipline that takes both knowledge and technical practice, as simply reading about a surgical technique is often not sufficient to allow performance of that technique. Surgical confidence, therefore, can obligate repetition within a framework of good decision-making, emotional and procedural support, exposure to many types of cases, and formative feedback.
While veterinary school can help prepare a veterinarian for many types of cases, actual surgical case-load during school may be minimal. Thus, many veterinarians are not given enough training opportunities to feel truly confident when beginning their surgical careers in general practice. Frequently, they are not provided the support within the clinical environment to truly learn how to manage surgical cases, and in some instances are even demeaned by other practitioners for lacking knowledge they were never taught. Many veterinary surgeons experience failures, either in anticipated surgical outcomes or in patient deaths, and they find themselves unable to overcome their self-doubt. All these events can further erode their confidence, and limit their mental ability to effectively expand their surgical skill set.
As a young veterinarian myself, I experienced both successes and failures that affected my practice for many years. The first patient I lost under anesthesia was during a dental extraction while still an intern. It was years before I could bring myself to stop anxiously hovering during any dental procedure. When I had asked for advice from one of the more experienced veterinarians on how to handle the complicated feelings I was having, I was told to toughen up because everyone loses patients. Needless to say, it was unhelpful and my surgical and anesthesia confidence took a huge hit.
During that same internship, I was demeaned by an associate veterinarian because of the perioperative death of a farm dog who had ingested rodenticide. I was unaware of the issue and nothing was mentioned to me until after the dog was in crisis. When I expressed my unhappiness at being scolded for an outcome I could not have predicted, I was told that I should not have such a poor attitude. Dog spays gave me serious anxiety for many years, and I would actively avoid them if possible.
On the other hand, I had an amazing mentor in the years after my internship who guided me through many surgeries, both simple and complex, and I regained a lot of my confidence in surgery and anesthesia. Unfortunately, I still do not enjoy dog spays.
Imposter Syndrome
Imposter syndrome was first identified in the 1970s and is a sense of “fraudulence” at work or in life. It often afflicts high achieving persons, especially ones who tend toward perfectionism. Imposter syndrome is defined as a doubt regarding one’s expertise or competency, usually despite evidence to the contrary. These individuals will often attribute success to external factors, such as luck, and failure to personal inadequacies. It can affect people of all genders and in numerous occupations. There is evidence that imposter syndrome may correlate with the amount of perceived responsibility, such as life-and-death situations or high stress decision-making. With all these factors combined, imposter syndrome is a common affliction in veterinary medical professionals.
Often, as mentioned above, imposter syndrome affects high-achieving individuals. Many times these people have been placed in an environment of competition, without the learned skills needed to accept failure. Even when the stakes are not as serious as life-or-death, a highly skilled individual who is outperformed by another may feel guilt, shame, or other emotions that can make them doubt themselves. Without the proper framework and support, and without the experience needed to correctly frame failure, even minor setbacks can cause someone to reframe their view of themselves in a negative way.
As a young veterinarian, I was on-call after hours several days per month. I found this time to be the time I felt the worst imposter syndrome, as I was often seeing these patients without support staff or other veterinarians to consult. Once, I missed a very obvious finding on a radiograph. Another time, I missed a pyometra because the dog also had a very bad case of pneumonia. I fretted often after-hours, thinking that I was not the one who should be in charge. I often felt I could not be trusted to make the right decision in any case, surgical or medical. At the time, one of the veterinarians I worked with suggested I “fake it until I make it”. As one can imagine, that did not help me with feeling like I was a fake; in fact, in my own head it made me feel more like an imposter.
Although I still can let my anxiety cause me to doubt my own skills, I was lucky to have great mentors since my first negative experiences, and it does not happen as often. I know how to plan a surgical case, I have developed good and quick basic technical skills, and I know that minor setbacks are just that - minor. Every surgery does not go perfectly for me, but I am able to see what I can do to improve, can debrief how to do better in the future, and overall am able to bring a more confident mindset to my cases. I have found confidence and skill in surgery is less of a “fake it until you make it” and more “try again until you master it”.
Surgical Training - Building Confidence
Training in surgery, just as in any other clinical discipline, should start with simple, repeated procedures to help develop technical skill and confidence. As surgical skill expands, additional tasks can be included. This sets the surgeon up for success, and builds confidence in routine procedures. As cases become more complex, the veterinarian finds themselves with the ability to take on more difficult or technical procedures confidently.
Exposure to many case types, whether actual or simulated, can help develop confidence in decision making both during surgery and in preparation for surgical cases. A good training environment can provide a variety of types of cases for both performance of surgery and observation. It can also allow the veterinarian an opportunity for participation in more complex surgeries without the ultimate responsibility toward the outcome.
A mentor committed to training confident surgeons can be invaluable in explaining why certain decisions were made during surgery, as well as providing the building blocks toward decision making before and during surgery. In most cases, the preparation, mindset, research, and plan for a surgery is as important as the procedure itself. Having a confident mentor to walk through the steps of a procedure and provide feedback during and after a procedure creates a positive learning environment and can help allay self-doubt.
Setting up for Success
Fortunately, a positive and interactive learning environment can provide the confidence and enhance the surgical skill set to overcome many of the barriers to surgical excellence and lead to development of self-assurance, creating well balanced and clinically excellent veterinary surgeons.
Repeated success within a supportive environment can continue to contribute to confidence in the surgical suite, even if previous experience has created an unsure and anxious surgeon. Explore the surgical training experience every veterinarian wishes they had with the Small Animal Soft Tissue Surgery Certificate program. This course is designed for veterinarians searching for a thorough surgical education, from an expansive case variety to support when preparing for surgery all the way through completing complex surgical cases with compassion and confidence.
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