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Surgical Competence Today: What Have We Gained? What Have We Lost?: Solutions: Improving Methods of Teaching Surgical Skills

Solutions: Improving Methods of Teaching Surgical Skills


Dr. R H Bell has suggested seven recommendations to improve surgical education:

  1. Insure that the trainee has undergone both cognitive and skills training (simulation) with the procedure before going to the operating room.
  2. Have the resident assessed (using validated metrics) before going to the operating room (OR) so the faculty surgeon will know the resident possesses a basal level of ability.
  3. Rehearse the operation on a simulator and discuss with the faculty member where major intra-operative decisions need to be made before going to the OR.
  4. After the operation, debrief with the faculty member and review areas of accomplishment and parts of the operation that need more work.
  5. Grade the trainee's performance and file the report in the resident's portfolio.
  6. Have the resident review a video of the case and practice in the skills lab those maneuvers proven to be difficult for the trainee.
  7. Keep a national database of resident experience for the purpose of research and norm-setting.

Concealed amid glowing statistics of improved surgical care–established primarily through advances in minimally invasive surgery–are disturbing reports of inadequate surgical resident training. This competency dilemma is accompanied by a shift away from surgery as a career choice by medical students who are burdened with school loans and who desire less stressful lifestyles. These and other related issues conspire to make quality surgical care problematic for Americans in the future. Without change, we will almost certainly witness the disheartening 1990 prophesy by Griffen and Schwartz who stated, "Eventually, our society will be "served" by a medical community that is less talented and definitely less interested in providing medical services in the tradition of its predecessors.
 

The American College of Surgeons and other surgical associations have formed a consortium called the Surgical Council on Resident Education (SCORE) and are aggressively pursuing a national surgical curriculum that is competency-based. The educational alignment of SCORE supports the notion of the pretrained novice employing simulation and surgical skills labs as a foundational commitment to patient safety and continued quality improvement. One would hope, with respect to resident work hours, that the special training requirements and patient care needs of surgeons would eventually be recognized. The current rigid delineation of duty hours is, in my opinion, incompatible with the assimilation of true surgical competence.

Source - http://www.medscape.com/viewarticle/733881_5

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