Dynamism in Surgical Training

Surgical Endoscopy, 2017

Background It is hypothesized that not all surgical trainees are able to reach technical competence despite ongoing practice. The objectives of the study were to assess a trainees' ability to reach technical competence by assessing learning patterns of the acquisition of surgical skills. Furthermore, it aims to determine whether individuals' learning patterns were consistent across a range of open and laparoscopic tasks of variable difficulty. Methods Sixty-five preclinical medical students participated in a training curriculum with standardized feedback over forty repetitions of the following laparoscopic and open technical tasks: peg transfer (PT), circle cutting (CC), intracorporeal knot tie (IKT), one-handed tie, and simulated laparotomy closure. Data mining techniques were used to analyze the prospectively collected data and stratify the students into four learning clusters. Performance was compared between groups, and learning curve characteristics unique to trainees who have difficulty reaching technical competence were quantified. Results Top performers (22-35%) and high performers (32-42%) reached proficiency in all tasks. Moderate performers (25-37%) reached proficiency for all open tasks but not all laparoscopic tasks. Low performers (8-15%) failed to reach proficiency in four of five tasks including all laparoscopic tasks (PT 7.8%; CC 9.4%; IKT 15.6%). Participants in lower performance clusters demonstrated sustained performance disadvantage across tasks, with widely variable learning curves and no evidence of progression towards a plateau phase. Conclusions Most students reached proficiency across a range of surgical tasks, but low-performing trainees failed to reach competence in laparoscopic tasks. With increasing use of laparoscopy in surgical practice, screening potential candidates to identify the lowest performers may be beneficial. Keywords Selection Á Technical skills Á Competence Á Surgical trainees Á Simulation training Á Learning curves Emerging evidence suggests that trainees acquire technical skills at variable rates, with a subset of students unable to reach competence [1-4]. Recent studies propose that 5-17% of trainees have an innate technical ability that allows them to rapidly acquire skills, achieving competence with minimal practice or effort [1, 3] In contrast, most trainees (63-70%) are moderate performers [1, 3]. They improve with practice, ultimately reaching a level of technical competence that is acceptable and safe. However, studies have also identified a smaller subgroup of trainees (8-20%) who struggle to learn technical skills and fail to reach competence even with continued practice (low performers) [1, 3]. Given that technical skill is a requirement for a successful surgical career, identifying these individuals early may benefit both prospective trainees and surgical programs. This is an original article, with no communication to a society or meeting.

ANZ Journal of Surgery, 2002

Clinical and technical skill may not be sufficient to fulfil society's expectations of surgeons. Other skills, which have been well defined in the published literature, include those of the professional, communicator, collaborator, manager, scholar and health advocate. It is the purpose of this review to explore the current understanding of these different domains and make comment about ways to improve training that will ensure that the surgeon of the future has the opportunity to develop broader expertize.

Postgraduate Medical Journal, 2021

Postgraduate training in surgical specialties is one of the longest training programmes in the medical field. Most of the surgical training programmes require 5–6 years of postgraduate training to become qualified. This is usually followed by 1–2 years of fellowship training in a subspecialised interest. This has been the case for the last 20–30 years with no significant change. The surgical practice is transforming quickly due to the advances in medical technology. This transformation is not matched in the postgraduate training, there is minimal exposure to the new technological advances in early years of postgraduate training. The current postgraduate training in surgical specialties is not fit for the future. Early exposure to robotic and artificial intelligence technologies is required. To achieve this, a significant transformation of surgical training is necessary, which requires a new vision and involves significant investment. We discuss the need for this transformation in th...

ANZ Journal of Surgery, 2009

Journal of Surgical Sciences, 2019

not available Journal of Surgical Sciences (2017) Vol. 21 (1) :2-4

Acta Cirurgica Brasileira, 2007

Surgeons' training requires professionalism, continuing medical education, and appropriate environment to ensure the desirable success. However, generally, this goal is pursued in an inefficient way, based upon intensive training skills founded in the age-old philosophy of "the way I have learned it". There is, usually, a lack of patient outcome evaluation, especially of long-term follow-up of surgical procedures, which in turns provide little evidence of senior surgeons for adequate training junior surgeons. On the other hand, questioning the established knowledge is not stimulated, or even not tolerated by the seniors. It seems like the "truth" is absolute and allows no change for the new knowledge, which would mean no additional progress. There is a need to significantly alter the implementation of new knowledge, if possible based on evidence, to ensure the best medical care for the surgical patient. Experimental surgery, and nowadays bench model surgery, may be useful in minimizing the predictable complications of patients under the surgeon training responsibility, while on learning curve. Surgery based on evidence should be one of the tools for improving patient surgical care, since this important branch of medical activity must rest on two pillars "art and science"; and surgeon in good training needs to be close to both.

International journal of surgery (London, England), 2012

In the past decade surgical training in the United Kingdom (UK) has seen radical overhaul with the introduction of formal training curricula, competency based assessment, and a new Core Surgical Training programme. Despite this, and in common with many other countries, numerous threats remain to sustaining high-quality surgical training and education in the modern working environment. These include service delivery pressures and the reduction in working hours. There are numerous areas for potential improvement and dissemination of best training practice, from incentivising training within the National Health Service (NHS) through top-down government initiatives, to individualised information and feedback for trainees at the front-line. This document sets out the current structure of surgical training in the UK, and describes the contribution to the current debate by the Association of Surgeons in Training. Highlighting areas for improvement at national, regional, local and individual levels, the Association proposes 34 action points to enhance surgical training and education. Adoption of these will ensure future practice continues to improve on, and learn from, the longstanding history of training provided under the guidance of the Royal Surgical Colleges. a On behalf of the Association of Surgeons in Training Council.

ANZ Journal of Surgery, 2009

Journal of the American College of Surgeons, 2001

In 1999, our world's population passed the six billion mark. An estimated one-third to one-half of our world's population-2 to 3 billion people-still lack basic surgical care! In this paper we attempt to address the question, "How best can surgical needs be met in a sustainable manner within resources available for training in less-developed populations?" Our goal is to raise awareness of the enormous unmet needs for surgical care in less-developed regions and to suggest ways in which Fellows of the American College of Surgeons may assist in helping meet the needs. In many developing countries, surgical training programs are patterned after North American or European programs. This tends to encour-age subspecialization and might not produce surgeons adequately trained to manage the broad spectrum of surgical needs for which people attend their local district hospitals. A complete roster of surgical specialists cannot be made available in most district hospitals throughout the world. So surgeons serving in these hospitals require training and experience that encompass a broader range of surgery than is provided by the usual programs for training general surgeons.

Bulletin of The Royal College of Surgeons of England, 2014

Journal of the Royal Society of Medicine, 2006

The Chief Medical Officer, Sir Liam Donaldson, has recently published his recommendations 1 on how the government should respond to the serious criticisms of medical regulation and the General Medical Council made by Dame Janet Smith in her final report of the Shipman Inquiry. 2 In a thoughtful and well-written report, he places the regulation of doctors within the wider set of systems for improving and quality assuring modern practice. Doctoring is at the heart of the healthcare system. Sir Liam's focus throughout is, therefore, on how to make sure that in future everyone in the UK who needs a doctor gets a good doctor. 3 It means that patients should feel they can trust any doctor without even having to think about it, 2 and that doctors themselves would entrust members of their family to any colleague without a moment's hesitation.

Journal of the American College of Cardiology, 2019

Advancing Surgical Education, 2019

Overview The development of a competent surgeon has evolved over centuries from a predominantly apprenticeship model to one that incorporates modern theories of learning accompanied by increasing awareness of the significant contribution from the hidden curriculum. Increasing public awareness and demands from educators and trainees have emphasised the importance of nontechnical competencies. The Royal Australasian College of Surgeons has determined nine core competencies as a basic requirement for surgical training. It has responded to emerging demands by the introduction of formal educational processes supporting the development of an educationally aware surgical teaching community. A challenge for surgical training is to balance the increasing demands on the surgical education workforce while delivering an expanded surgical curriculum that best serves the modern community. This chapter explores the changing field of surgical education and provides an overview of the future challenges.

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...

Bulletin of The Royal College of Surgeons of England, 2012