Continued comments on changes in the education of residents in surgery

Article Abstract:

Several views on proposed changes in graduate surgical education are presented. Drs. Friedman and Griffen note that it is important that surgical residents be exposed to all the main elements of general surgery during the five-year period of residency training; it is equally important that residents receive a good education in the treatment of critically ill patients. The Residency Review Committee of the American College of Surgeons insists that all residents receive an equivalent educational and clinical experience; a minimum requirement for experience is being defined. Today 60 percent of general surgery residents do not remain in general surgery, but pursue other surgical specialties (thoracic surgery, plastic or reconstructive surgery, etc.). General surgery residents must be broadly trained, but must also be able to perform complex general surgical procedures. Because these are not commonly performed operations, the opportunity to perform these procedures does not frequently occur. It would appear to be reasonable that the opportunity to perform these operations be given to residents who are most likely to remain in the field of general surgery. Drs. Friedman and Griffen define the need to define the educational experiences necessary for surgeons planning to go on to a surgical specialty. Dr. Folse suggests that the Boards of the surgical subspecialties review the possibility of selecting residency candidates after three or four years of general surgery residency. Dr. Polk notes the risk of having different tracks of surgical education, particularly if career choice is changed midstream. An additional problem is that over the years these subspecialties have been assiduously increasing their own standards, yet they may now be asked to allow their trainees to forego what may be the most significant year in their surgical training, their last year. This approach would probably lead to increased time training for a narrow specialty. The problems of length of training, quality of education and where that education should lead must be dealt with by leaders in the surgical community. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Beliefs, opinions and attitudes, Residents (Medicine), Medical education

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The future of general surgery

Article Abstract:

Since World War I there has been a trend toward specialization within the field of surgery. Between 1917 and 1950 there were 11 surgical specialty boards established: ophthalmology, otolaryngology, obstetrics and gynecology, orthopedic surgery, colon and rectal surgery, urology, surgery, anesthesiology, plastic surgery, neurological surgery and thoracic surgery. It is important that further fragmentation of the field of general surgery not occur. Many patients seeking health care view specialization as a way of reassuring themselves that they are getting the very best possible medical care. Recently there has been interest in subspecialization within general surgery. Other areas influencing the future of surgery are discussed. Residency and training requirements change with time. A few years ago the minimum requirement for surgical training was reduced from five to four years, but was soon revised back to five years; today some believe six years of training should be the minimum. Further training is then taken in the specialty area. There is discussion on revising the training program to teach a core of surgical knowledge common to all surgical specialties, and provide more general surgical experience for residents planning to practice general surgery. Manpower analysis suggests that there will not be enough general surgeons, but those surgeons will work fewer hours, there will be fewer solo practices, and retirement will be earlier. Physician's incomes have increased significantly, and it is expected that there will be restrictions placed on physician incomes in the near future. Patterns of practice are changing. A significant change has been seen in the type of operations performed in short-stay hospitals. Changes have also taken place in technology, approach to diagnosis and treatment and philosophy of patient care, as well as physician reimbursement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Medical specialties, Medical fees

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The future of general surgery training

Article Abstract:

It has been questioned whether general surgery can survive in this era of specialization. Surgical training programs parallel the evolution of surgical specialties. General surgery is usually looked at as the parent of most other surgical specialties. In medical schools it is the general surgery faculty that provides the core surgical training, both for general surgery and the surgical specialties. As the specialties have become more narrow, care of the basic surgical needs of the patient, especially the critically ill patient, is often the responsibility of the general surgeon. If general surgery were to be given a narrower scope, this would eliminate the solid foundation in basic surgical science and fundamental patient care that is part of surgical education in medical school, and upon which later specialty training is based. In terms of society's needs, the majority of medical and surgical care is provided outside the academically oriented hospital. In many places, the general surgeons are the main providers of emergency and trauma care, and are leaders in the critical care units of their hospitals. Even with the availability of new technologies, we should not discount the need for general surgeons. Surgical training programs should establish requirements for incoming trainees to insure a solid understanding of the basic sciences. The early years of training should be directed toward fundamental care of the surgical patient; later years should be devoted to complex operations and disease management. Rotation through various specialties is no longer practical. Revisions in the educational programs should be linked to the broad practice objectives of the specialty. (Consumer Summary produced by Reliance Medical Information, Inc.)

Curricula, Graduate medical education

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