As academic lecturers and industry trainers, we're frequently approached by those just finishing training as well as those out decades, concerned about how best to develop and improve procedural skills. During residency and fellowship, doctors are immersed in an environment of learning. Even if we aren't spoon fed, there's the aspect of trial by fire when there are other more experienced physicians around as a safety net. Once out of that venue, how do we continue to grow and become true experts without compromising our patients' best interest or reputations?
Concern about staying ahead of the curve to deliver optimal cosmetic results to patients is certainly natural. Medical and surgical training for physicians is based on developing a healthy balance of doing no harm and of confidence that you are capable of delivering excellent outcomes. Most podium experts completed formal training at a time before many of the products, devices, and procedures about which they are teaching existed. Indeed, botulinum toxins were just beginning to be used for aesthetic purposes and none of our modern injectable fillers (let alone lipolytics) existed when the chief medical editors of this journal trained. And yet, that is an area both of us are perhaps known for best. The same can be said for the plethora of devices we use on a daily basis.
Beyond putting aspiring cosmetic practitioners at ease, the fact that we are regularly using agents and performing procedures not covered during our formal training is a comment on how we develop and incorporate best practices as physicians. Residency and fellowship training provide the foundation and guiding principles for future learning. It is the toolbox to which we add over time as science and technology progress. Without that core knowledge, no amount of training will prepare us to harness the newest innovations in our field.
Integral to this is finding the right educational venues. There are so many wonderful academic and CME meetings where physicians of all ages can absorb full details of procedures and collect “pearls” on best practices. While training from pharmaceutical companies is appreciated and often is the only way to get hands-on training, the restriction to FDA on-label indications is limiting. It is critical for clinicians to also be exposed to the off-label discussions, which are frequently in the better interest of our patient outcomes. We advise physicians to take advantage of the offerings of their societies, multidisciplinary groups, and various CME companies. So-called “curbside” consults with faculty and colleagues at meetings in hallways, social gatherings, and advisory boards provide the needed segways between the two. And having a circle of colleagues with whom each of us can speak freely about outcomes—good and bad—is the key to continuing to grow as an expert. American physicians running a busy practice can't take months off to do another fellowship, but when possible, spending the day shadowing a colleague in his or her office when visiting another city is a unique opportunity to get the kind of learning usually reserved for trainees.
No matter our age or level of training, none of us should ever leave out the possibility of more training. As important, we should never undervalue time spent sharing and discussing ideas with colleagues, whether that's with our peers, mentors, or mentees. To paraphrase a colleague going on his fifth decade of practice, “I never stop learning new things and I never get bored.” Those of us lucky enough to be in this multidisciplinary field need to embrace that sentiment and take advantage of the educational opportunities around us to maintain our position as leaders in aesthetic medicine.
Heidi Waldorf, MD, FAAD, and Steven Dayan, MD, FACS