Management of educational change in times of medical reorganization

Article Abstract:

The Association of Surgical Education was formed to deal with undergraduate education in surgery. Although there is a increasing interest in graduate education at the residency level, there is little research dealing with education at this level. It is important that the gap between undergraduate and postgraduate education be bridged. Various factors are changing the quality of medical education, especially increasing government involvement and changes in the hospital mix brought about by diagnosis-related groups and health maintenance organizations. The changes in types of patients admitted to the hospital have not been paralleled by changes in the education of medical students or residents, to reflect the shift toward community-based ambulatory outpatient care. The volume and types of inpatient surgery are declining. Changes in education must start in the medical schools. Not only researchers but teachers should be rewarded, recognized and promoted. A strong central authority is needed to formulate and continually assess the curriculum. In addition to defining the content of curriculum, how and where teaching is done needs to be redefined. Today, the patients seen at the large teaching centers are seriously ill patients, often representing failures of treatment given at smaller centers or in the community; thus the case mix of these centers is no longer appropriate for training medical students or residents. It is important to extend the educational setting beyond these centers, particularly to the outpatient clinics. Teaching in these settings is not easy. Changes of this scope require careful planning, a realistic perspective, active management and continuing assessment. Teaching should be focused, more than in the past, on the needs of those surgeons planning to enter community practice rather than academic practice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Education, Curricula, editorial

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Surgery interns' experience with surgical procedures as medical students

Article Abstract:

The technical aspects of surgery are first taught in medical school. First-year surgical residents, or surgical interns, are expected to perform simple procedures. A survey was taken of forty incoming surgical residents to determine what technical skills they had developed while in medical school. Commonly performed procedures included placement of: nasogastric tubes (97.3 percent), urinary indwelling (Foley) catheters (94.6 percent), and central venous, arterial and pulmonary arterial lines (78.4 percent). More complicated procedures, such as placement of chest tubes and arterial lines, were performed less frequently. Sixty percent of the first-year residents had assisted in closing incisions at surgery, but only 22 percent had assisted in other aspects of surgery. The acquisition of surgical skills during medical school did not correlate with the duration of surgical experience. Almost half of the first-year residents (49 percent) had worked in animal surgical laboratories during medical school. These findings indicate there is a lack of technical training in medical school. The development of technical skills is often unstructured during surgical clerkships of medical school; there is little student monitoring or feedback. Those who assign initial duties should be aware of the lack of experience of beginning surgical interns, or first-year surgical residents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical students, Surveys, Training

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Surgical training and implementation of emerging surgical technologies

Article Abstract:

United States, Health Care and Social Assistance, Surgical Procedures, HEALTH SERVICES, Methods, Innovations, Accreditation (Education)

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