A Chance to Cut is a Chance to Cure

Wednesday, October 27, 2004

The Future of Surgery, Redux....
From the September edition of theBulletin of the American College of Surgeons: Changes in resident training affect what you can expect from your next partnerThe treatise begins with an examination of surgical evolution:

Seventy-five years ago, your next partner would have been described as male and self-sacrificing. He would have done a residency that required that he literally live at the hospital with no time for any other activities and no remuneration. He would have operated in a less-than-sterile environment with a small staff and little more than scalpels and ether with which to work. A surgeon who was just entering practice 10 years ago would have been described slightly differently. Potential partners at this time could have been either male or female. These individuals would have been accustomed to operating in a sterile operating room with many technological resources and a large operating team at the ready. However, one adjective would have remained the same over the years. Surgeons of 10 years ago continued to be seen as self-sacrificing. They would have gone through residencies that still offered minimal remuneration and punishing hours that left little time for family life or other interests. Through the years, these rigorous training regimes were believed to be vital in the production of competent surgeons.

How things have changed....

So what will potential partners look like in this century? Everyone hopes for a partner with cool confidence, high-tech capabilities, incisive decision making capabilities, and a slavish devotion to work. A futuristic "Star Trek"-like physician comes to mind. But, with new regulations affecting the number of hours residents may work, the image may be different than expected. The new generation of surgeons will have had limited work hours and will have been required to take less call. They will have been forced to take a day off every week and will have been permitted to sleep after long nights awake. All of these new ways of training residents will definitely affect the way surgeons approach

I don't believe that Dr. McCoy was the product of an 80 hour work-week limit. Anyway, the critics of the work-week limits have concerns about what is going to be coming out of these programs in the next few years:

Whenever change occurs, naysayers start raising their objections. Skeptics of work-hour reform have voiced a multitude of reasons why the reforms are bad for surgical training, including the lack of continuity of care, an erosion of the work ethic, lesser quality of care, a poorer educational experience, weakened skills, and inadequate readiness for practice. These critics portray your next partner as a buffoon with Frankenstein's hands, Homer Simpson's brain, and SpongeBob Squarepants's sense of responsibility.

The authors take a contrarian view of that opinion:

It is our contention that if surgical educators make the system more humane, more caring and well balanced surgeons will emerge, and, ultimately, we will see improved patient outcomes and increased student interest in surgery.

They end with the "following challenges":

1. Embrace the work-hour regulations as a step in the right direction toward fulfilling our duty to produce whole physicians, ones who heal with compassion and humanity.
2. Look into other ways to promote resident well-being.
3. Study New York City residents to see whether the 405 regulations have affected them.
4. Revamp the education process for residents to fit into the ACGME regulations.
5. Use the changes to attract a broader scope of medical students.

The short-term results appear to be good, but this is one of those things that will take several years to shake out.

Labels: Future of Surgery