Ongoing Pursuit of Excellence: Surgeons Can Advance Orthopaedic Surgery through Self-Reflection and Improvement

As orthopaedic surgeons, our professional journeys are shaped by our training, mentors, and experiences in the OR and clinic. We often find ourselves immersed in routines—methods we’ve learned, procedures we’ve mastered, and clinical outcomes we expect to achieve. Yet, there comes a point when we must pause, reflect, and ask ourselves, “Is there a better way to do this?” For me, this moment came in the realm of clubfoot treatment, an area where I once felt confident in my abilities, only to realize that I had much more to learn.

Orthopaedic surgery, like any other medical specialty, is built on a foundation of knowledge passed down from one generation to the next. In my training, I was taught the Ponseti method for the management of clubfoot by some remarkable surgeons. These mentors were pioneers in their own right—experts in neuromuscular conditions, complex hip reconstructions, and limb-deformity correction. However, looking back, I now recognize that although they excelled in many areas, clubfoot pathology wasn’t their primary focus. This is not to discredit their teachings; on the contrary, I owe much of my career to their guidance. But their expertise lay elsewhere, and clubfoot management, though seemingly straightforward, requires a depth of understanding that I had yet to fully appreciate.

As surgeons, we often view certain procedures as routine or “simple,” and clubfoot casting can fall into this category. After all, how hard can it be to apply a cast? Many of us think we can manage clubfoot effectively without needing to specialize in it, but this mindset is fundamentally flawed. The Ponseti method is not merely about placing a cast; it is an intricate and highly skilled technique, requiring precision, practice, and an understanding of the subtleties that can make or break a good outcome. It is every bit as demanding as performing a posterior spinal fusion for scoliosis or a complex limb reconstruction for a lower-extremity deformity. And yet, how often do we take this complexity for granted?

My time spent with Jose Morcuende, MD, PhD, FAAOS, at the University of Iowa through the Neubauer Fellowship profoundly shifted my perspective. Immersing myself in the history and evolution of the approach developed in the 1940s by the University of Iowa’s Ignacio Ponseti, MD, I gained insight into the trials he faced in promoting a nonsurgical solution for clubfoot—a method that went against the prevailing surgical dogma of his time. The results were revolutionary, proving that invasive, life-altering surgeries were unnecessary for most children with clubfoot. What struck me most during my time in Iowa was not just the clinical success of the Ponseti method but also the cohesive, highly skilled team behind it. They treated children with a wide range of complex clubfoot conditions, and their precision, efficiency, and ability to instill confidence in families were remarkable. This work was not “dabbling” in clubfoot management; this was mastery.

The experience reinforced a lesson that is often easy to overlook in the hustle of surgical practice: the importance of lifelong learning and continuous self-assessment. No matter how skilled or experienced we become, there is always room for improvement. We may have years of practice under our belts, but that doesn’t mean our way is the only way—or even the best way. In fact, becoming complacent with our current level of knowledge is one of the greatest risks we face as surgeons. Medicine is not static. It evolves, and so must we.

Lifelong learning is the bedrock of surgical excellence. To push the boundaries of what we can achieve for our patients, we must be willing to admit that there is always more to learn. This mindset requires humility—acknowledging that we don’t have all the answers and that our skills and knowledge can and should be refined. Whether it’s auditing our own techniques, like I did with my approach to clubfoot, or seeking out new methods from colleagues who specialize in areas we may not, the pursuit of knowledge is never-ending.

But the drive to continually improve isn’t just about us—it’s about our patients. They are the reasons we do what we do, and they deserve the very best care we can provide. That care is not limited to what we already know, but what we can continue to learn. By expanding our horizons, seeking out new experiences, and refining our techniques, we elevate not only our own practice but also the standards of care for all patients.

We should also recognize that mentorship and collaboration play critical roles in this process. Early in our careers, we learn from those who came before us—our mentors who generously share their knowledge and skills. But as we progress, we must continue to seek out mentors who have deeper expertise in specific areas, even if we have years of practice ourselves. Visiting colleagues who have honed a particular technique or asking for feedback from peers with different experiences can be invaluable. These interactions help us refine our own methods, learn new strategies, and ultimately improve the care we provide.

In today’s rapidly advancing medical landscape, lifelong learning is not optional—it is essential. New and evolving techniques and a deeper understanding of pathology are constantly reshaping the way we approach orthopaedic surgery. By embracing this reality and remaining committed to continuous education, we not only honor the legacy of the surgeons who came before us but also ensure that we remain at the forefront of our field, delivering the best possible outcomes for our patients.

I encourage my fellow orthopaedic surgeons to take a step back and reflect on their own practices. Ask yourselves: Am I achieving the best possible outcomes for my patients? Is there something I could do better? Be willing to challenge your own assumptions, seek out new learning opportunities, and embrace the idea that we are never truly finished learning. Whether it’s through formal fellowships, peer collaboration, AAOS-created educational opportunities, or self-directed study, the path to excellence is one that requires continuous effort, introspection, and growth. For the sake of our patients and our profession, we must commit to this lifelong journey.

Sean A. Tabaie, MD, MBA, FAAOS, is a pediatric orthopaedic surgeon and associate professor at Nationwide Children’s Hospital in Columbus, Ohio, where he leads the Neuro-Orthopaedics Program and serves as medical director of the Honda Center for Gait Analysis and Mobility Enhancement. Dr. Tabaie is also a member of the AAOS Board of Directors.