Failing to Prepare is Preparing to Fail: The Known, The Known Unknown, and The Unknown Unknown

Abstract

Cardiothoracic surgery residents often enter their training with fairly limited prior exposure to the field. Obviously, they need to master the essential knowledge and skills of the discipline during their training. In addition to following a didactic curriculum of one sort or another, much of the necessary knowledge and understanding will accrue from their experiences caring for and operating on the patients who will be under their auspices, not only during their formal training but also after they finish their training.  Some of these cases and situations, such as elective cases, allow for careful preparation, while some more urgent or emergent cases require generic, advance preparation in order to be ready to perform optimally in these cases when they arise. And then there will always be cases for which one will not be able to prepare in any meaningful way, and these types of cases will require creativity and innovation “on the fly.”  I will describe three cases, which are examples of each of these situations, with suggestions on how to handle each type of situation optimally. I will describe the preparation, such as it was for each, in some detail to help the reader understand how it felt to deal with each of these cases. The technical details of each of these cases resulted in a publication, which will be cited in the references, should the reader want to learn more about them.