Education And Training

Until the beginning of the 20th century, nearly all training of surgeons was by passing down the conventional knowledge from previous surgeons—this was not based upon any scientific principles, but rather by ritual and tradition. In 1908, Senn was the first surgeon to criticize this practice (8), and bring forward the scientific principles of using observation and experience for education and training. Although this mentoring process continued, it was strict scientific principles, gained through experimentation and evidence, that formed the basis for surgical education and training. The Halstedian method of apprenticeship has become the model for surgical training, based upon rigorously applied scientific principles. However, this model is somewhat capricious, with the determination of competency of the resident being at the discretion of the supervising faculty and department chairman. With the exception of the written examination of the resident's knowledge, there are no objective measures of performance.

There is a new paradigm emerging in the field of surgical education. Objective measures are the new basis for training and assessing residents. Some of this change is being driven by new training methods, such as the Objective Structured Clinical Exam and the Objective Structured Assessment of Technical Skills (9). Other pressure is coming from the need for objective demonstration of competency. One technology that is fueling this change is the use of surgical simulators that can accurately measure hand motions and quantitatively report psychomotor skills. This ability to measure is driving the most fundamental change of all—that of training for a given period of time to the new paradigm of setting of criteria which the resident must achieve before progressing to the next level—so called criterion- or proficiency-based training. In 2002, Seymour et al. demonstrated unequivocally that residents that train on a simulator perform better in the operating room, taking less time and making less errors (10). Thus, the time is near when every resident will have to train on a simulator to reach a certain level; those who have better skills will achieve it faster, those who are slower will take longer. However no resident will operate on a patient until they have passed the simulator by achieving a high level of technical proficiency. No longer will residents be permitted to "practice" on patients. This will eventually spread to all surgeons, especially in learning new procedures such as laparoscopy. A week-end course may or may not be long enough—for the gifted surgeon may be able to demonstrate proficiency in that short period of time, while others may need further training. For the long-term maintenance of surgical privileges, it will be required to be recertified, including technical skills on a simulator. Eventually, each surgical procedure will be objectively assessed, as a method to continuously assure maintenance of surgical skills. This is not unlike the requirement for airline pilots today. Thus, surgical simulation and continuous assessment of performance to an objective level of proficiency will become the new standard for training, assessment, credentialing, and practice.

0 0

Post a comment