Evidence and experience: what is the balance in surgeons' training?

Innovative Surgical Sciences, 2019

The first residency programs for surgical training were introduced in Germany in the late 1880s and adopted in 1889 by William Halsted in the United States [Cameron JL. William Stewart Halsted. Our surgical heritage. Ann Surg 1997;225:445–58.]. Since then, surgical education has evolved from a sheer volume of exposure to structured curricula, and at the moment, due to work time restrictions, surgical education is discussed on an international level. The reported effect of limited working hours on operative case volume has been variable [McKendy KM, Watanabe Y, Lee L, Bilgic E, Enani G, Feldman LS, et al. Perioperative feedback in surgical training: a systematic review. Am J Surg 2017;214:117–26.]. Experienced surgeons fear that residents do not have sufficient exposure to standard procedures. This may reduce the residents’ responsibility for the treatment of the patient and even lead to a reduced autonomy at the end of the residency. Surgical education does not only require learning...

Journal of Surgical Education, 2010

OBJECTIVES: This study was conducted to assess the knowledge and attitude of surgical trainees toward evidence-based medicine (EBM) and their perceived barriers to its practice.

International Journal of Surgery, 2011

Surgeons are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the 'best practice' from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research. We have adopted an approach first pioneered in emergency medicine, namely the Best Evidence Topic or Best BET. Clinicians select a clinical scenario from their daily practice that highlights an area of controversy. From this, a three-part question is generated and this is used to search Medline and other appropriate databases for relevant papers. Once the relevant papers are found, these papers are critically appraised, the relevant data to answer the question is extracted, tabulated and summarised. A clinical bottom line is reached after this process. The resulting BETs, written by practising surgeons can then provide robust evidence-based answers to important clinical questions asked during our daily practice.

Oman Medical Journal, 2012

Surgery as a discipline has perhaps been slower than other specialties to embrace evidence based principles. Today, surgeons all over Asia are prepared to challenge the dogma of yesterday. Surgical science which rests on a strong foundation of laboratory and clinical research can now be broadened to include the armamentarium of evidence based practice to advance surgical knowledge. The sheer volume of easily accessed information creates a new challenge. This article discusses keeping up with new information and finding the best available answers to specific questions amidst all the other information.

2000

With the national focus on patient safety, the importance of understanding the principles of evidence-based surgical practice and outcomes research has never been greater. The surgery literature manifests the continuous striving of the surgical profession to improve the delivery of healthcare and develop and incorporate new technologies into practice. Advances such as imaging and minimally invasive interventions have blurred boundaries among some specialties. Patient safety has become an area of national focus and priority. These trends, coupled with the rising demand for surgical services, the close scrutiny of health-care costs by government and managed care, consumers' increasing independence in selecting their own care, and, especially of late, the malpractice crisis in the United States, require all surgeons to understand the development and application of evidence-based surgery and surgical outcomes research. Evidence-based surgery draws from the fields of medicine and public health and centers on the acquisition, evaluation, and application of evidence for the care of the individual patient. More broadly defined beyond the care of the single patient, evidence-based surgery also encompasses population-based outcomes research focused on clinical, economic, and patient-reported data. This chapter was written to assist surgeons in producing and interpreting "evidence" related to surgical practice, for use in educational and patient care forums alike.

Updates in Surgery, 2019

International Journal of Surgery, 2008

Background: Despite evidence against its utility, many surgeons continue to employ prophylactic nasogastric decompression in elective colonic resection. This study aimed to establish whether an easy and practical intervention, mailing out a summary of current evidence to surgeons, can change surgeons practice to bring it more in line with current evidence. Methods: The use of prophylactic nasogastric (NG) decompression in elective colonic resections was documented for the 2 consecutive months of October and November, 2004 at the Royal Alexandra Hospital (RAH). A one page summary of recent evidence concerning this practice was then mailed to all general surgeons at that institution. A similar second review was carried out for the months of January and February, 2005. The two periods were compared with regards to prophylactic NG use. Results: Twenty two patients underwent elective colonic resections during the months of October and November, 2004. Twenty one patients underwent such procedures in January and February, 2005. Seven out of the 22 cases in the first group (the pre-intervention block) received prophylactic NG decompression. Five out of the 21 cases in the second group (the post-intervention block) received prophylactic NG decompression. The difference in prophylactic NG use between the two groups was not statistically significant. Conclusions: This study has shown that mailing out a summary of current evidence to surgeons concerning a certain issue is not sufficient to lead to a change in practice.

BMJ: British medical journal

Gynecological Surgery, 2008

Every surgeon will experience a learning curve while performing a new surgical procedure. Developing surgical training will shorten the learning curve, with less deleterious effects on patients during this period. There are exciting initiatives in different branches of surgical training that will be applicable across all surgical disciplines. These involve the combination of didactic repetitive training, coupled with skills training where it is applicable. These initiatives will help to move the focus, from developing technical excellence for a few individual surgeons to a more widespread approach in the training of complex laparoscopic surgery, resulting in considerable health benefits to patients.

BMJ, 2004