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Ethics Debate: Must Surgeons in Training Programs Allow Residents to Operate on Their Patients?

Wednesday, June 17, 2015

To what extent must surgeons be required to have residents operate on their patients to satisfy board requirements? Richard Ohye of the University of Michigan and James Jaggers of the University of Colorado debate this complex question, including the issues of patient safety, public reporting, and commitment to training residents. Robert Sade moderates the debate, which was filmed at the 2015 STS Annual Meeting.


do we really need to have this conversation/debate again? This goes hand in hand with the complaints that program directors have that the graduating residents from general surgery programs can't operate and the residents are doing more and more years in fellowship to gain confidence. I've been hearing this for 20 years, oh yeah, the same time we started a more gentle and loving residency program so the residents wouldn't get too tired. Today. we allow the MBA's to manipulate the way we practice under the umbrella of "quality" measures. Now we have collaegues saying we need 7 years to train residents to do general surgery because they need those extra 2 years of "acute care surgery" The bottom line is every cardiac surgeon should not be training residents. I remember when I started training residents, you need to know that there's nothing the resident can get you into that you can't get out of, if you don't feel that way, then don't teach. Hopefully at some point before I die, someone in the education committee of our specialty will stand up and say " this is the way we need to train cardiac residents to be the best in the world. We will decide how long they work each day and how many years they need to train to be able to do that Norwood Dr. Ohye refers to. Not the administration, not the CMS, not the ethics committee or the quality nurses with there clipboards and smart phones. We had the best system to train the cream of the crop to be the best surgeons on the planet, we gave it away. Why we did that, we better figure it out before someone who has never taken care of a patient in his life does it for us.
An excellent and relevant comment by Dr.Kerr. I trained out of Boston and I had an opportunity to see the previpusbsytem with no hour limits and then the famous 80 hr limit or whatever. I don't think we should have some MBA or nurse practitioner tell us how to train our residents. I would never have learnt all I did in those years if I hadn't put in the time. So one has to ask the question who is the best judge of how to train the program director or the ethics committee. Wake up folks take control.of our future and our training. Or we won't have any decent surgeon to operate on us when we need it. Rehan
I couldn't agree more with Dr Kerr. When we trained there were no set hours, there was a continuity of patient care, there were stimulating little discussions with the mentor/s through the operations, through the outpatient visits, through the ward rounds, and through the thesis work. There were also on-call duties for general emergency and emergency CTVS care, there were weekly seminars, journal clubs, and experimental lab work, angiocath lab work, outpatient investigations /minor surgeries. It was a continuum of care and learning. Heirarchy of trainees of 3-4 yrs was always there to supervise and help. Somewhere down the line specially in the corporate and private hospitals, we lost all that, got professional managers to dictate to us, professional boards to have us on the public domain and mentoring has taken a back seat. In the excellent enquiry report of Sir Temple and earlier Lord Darzy the value of mentoring has been emphasized as the way to take good care of patients and produce good results for the next 30 years of a trainee's life
The hours restrictions are self-reported. There are many trainees in many specialties that have work hour restrictions who figure out how to train to become good and safe surgeons. And definitely, there will be excellent surgeons out of the current training scheme, as each gains experience. The issue is that we continue to attract individuals who lack motivation, the passion, and the dedication to the profession, and hide behind a self-reported hours restriction to limit training and exposure. Those that are highly motivated and committed to being the best they can be are likely seeking other specialties or professions. The specialty and cardiothoracic surgery community at large need to adapt to the changing world and figure out a way to have CT surgery regarded as the premier surgical specialty by the public, and attract the best of the best (ie, the ones that will figure out a way build a spaceship left alone in the middle of a jungle).

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