Clinical expertise is an essential part of practice of orthopaedic surgery. Securing an ample knowledge base, including a grasp of relevant scientific literature to determine evidence-based means of practicing, is lifelong process. As a resident and fellow, you will be on a steep learning curve garnering psychomotor skills, technical familiarity, and then expertise. Technical proficiency will continue for some period of time as you enter your first practice. It takes many thousands of cases to become optimally facile as a surgeon, and some people have more innate ability to perform well as a surgeon, making their pathway more efficient.

Communication skills with your patients and their families and support systems are also something that should continue to mature with time and experience; it goes without saying that in order to be an effective and proficient surgeon, you should have excellent communication skills, including those in interactions with ancillary staff and other colleagues.

Systems-based practice entails working effectively in healthcare settings: outpatient clinics, surgery centers, hospital wards, operating rooms, and other locations. It involves integration of care, often across multiple of these settings, and it may include interactions with other specialty providers in direct care of your patient, or in referral or consultation. Understanding and developing cost-effective practices and assessing and refining your practices over time are all essential parts of a high-value surgical practice.

Practice-based learning refers to placing your work in the greater context of individual patient lives and community concerns. Engaging in continuing education, ranging from expansion of your knowledge base, incorporation of new technologies, and adjustments of practice metrics and tactics are key aspects. These mean that you will be observing results, measuring outcomes, and reflecting on the most effective course of care, all which are crucial ingredients to a successful surgical practice. In the end, patient outcomes will hopefully be optimized.

Professionalism in clinical practice refers to integrity of care. Maintaining values of honesty, transparency, quality, and value form the basis for professional success. Managing relationships with patients and with your workplace colleagues with compassion and respect will provide foundation to weather challenges as they arise and will afford the basis for professional growth and maturity.

Whether or not you practice in an academic setting, some academic goals are imperative to remaining safe in your care of people and to become proficient and cost-effective over time. Continuing with your education is essential. Various resources exist; identifying specific journals and professional resources, such as books, courses, webinars, or other educational methods that provide an appropriate level for your personal learning needs, early in your practice is important. Over time, new resources will become available and can be investigated. Communications with colleagues in your practice or within your specialty may provide good advice. See Chapter 41 regarding lifelong learning and Chapter 43 for descriptions of educational resources.